Implantable Devices Lead Extraction with the Excimer Laser Sheath: A Single Center Experience

Objectives: Chronic leads are firmly fixed and adherent to the tissue therefore the removal of such leads might cause fatal complications. Therefore, the excimer laser assisted removal of implantable device leads is a very challenging procedure. It is often indicated in case of infection, lead malfunction, system upgrade or venous obstruction. The aim of this report is to pronounce the safety and effectiveness of excimer laser-assisted lead extraction.

Methods: Excimer laser sheath extraction (Spectranetics™, U.S.A.) was performed if conventional extraction techniques left doubt for complete system removal. In all patients excimer laser sheath extraction was performed under ECC standby and under TEE monitoring. Patients were informed about surgical stand- by option.

Results: Between November 2012 and September 2014 64 Implantable devices leads in 30 patients [mean age (62.4 ± 17.1) years, range 17–82 years] were extracted using excimer laser sheath. 21 patients had Class I indications for lead extraction, 9 patients for Class II indications. The mean implant time was 82.7 months (range 12 to 204 months). In one case the lead could be partially extracted otherwise all other leads were successfully completely extracted (success rate 98.43%). All extractions were performed in and operation time under 120 minutes and with no complications.

Conclusion: Our experience suggests that excimer Laser Sheath Lead extraction System is a safe and effective tool in extracting chronic implantable device leads. It can be seen as a less invasive method in comparison with the surgery with ECC . It should be performed with experienced operative standby.