Application of Excimer Laser for Percutaneous Extraction of Pacemaker and Defibrillator Leads: Experience from the Hunter Holmes McGuire Veterans Administration Medical Center and the Virginia Commonwealth University
Over the last decades, the clinical need for managing the consequences of chronically implanted intravascular cardiac pacemaker or defibrillator leads has grown exponentially. Lead failure and new indications for an upgraded device therapy often requires new lead implantation in a limited central venous “real estate”. In addition, device implantation in patients with increasing comorbidities resulted in higher infection rates and cure in these cases is unlikely without complete system removal. While removal with simple traction of recently implanted leads is often sufficient, once significant fibrosis takes place around the lead (usually after 6 -12 months), use of special extraction tools often becomes necessary as traction may cause complications or incomplete lead removal. Among the numerous older and newer advanced lead management modalities, the most extensive clinical experience and supporting data from multicenter trials has come from the use of the excimer laser technology.
In this chapter, we discuss the main principles of lead extraction, including indications, perioperative management with particular focus on the laser lead removal technique and present outcome data from the Hunter Holmes McGuire VA Medical Center and the Virginia Commonwealth University.
KeywordsExcimer laser lead extraction ICD lead Pacemaker lead Device infection Lead fracture
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