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Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions

Journal of the American College of Cardiology, 2010-02, Vol.55 (6), p.579-586 [Peer Reviewed Journal]

Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Feb 9, 2010 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2009.08.070 ;PMID: 20152562

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  • Title:
    Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions
  • Author: Wazni, Oussama ; Epstein, Laurence M ; Carrillo, Roger G ; Love, Charles ; Adler, Stuart W ; Riggio, David W ; Karim, Shahzad S ; Bashir, Jamil ; Greenspon, Arnold J ; DiMarco, John P ; Cooper, Joshua M ; Onufer, John R ; Ellenbogen, Kenneth A ; Kutalek, Stephen P ; Dentry-Mabry, Sherri ; Ervin, Carolyn M ; Wilkoff, Bruce L
  • Subjects: Aged ; Binding sites ; Defibrillators, Implantable - adverse effects ; Device Removal ; Diabetes ; Embolisms ; Equipment Failure ; Female ; Humans ; Infections ; Lasers ; Male ; Middle Aged ; Mortality ; Ostomy ; Pain ; Retrospective Studies ; Success ; Thrombosis ; Time Factors ; Veins & arteries
  • Is Part Of: Journal of the American College of Cardiology, 2010-02, Vol.55 (6), p.579-586
  • Description: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients. The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices. Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included. Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index <25 kg/m(2) and low extraction volume centers. Procedural failure was higher in leads implanted for >10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index <25 kg/m(2). Overall all-cause in-hospital mortality was 1.86%; 4.3% when associated with endocarditis, 7.9% when associated with endocarditis and diabetes, and 12.4% when associated with endocarditis and creatinine > or =2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine > or =2.0. Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m(2). Centers with smaller case volumes tended to have a lower rate of successful extraction.
  • Publisher: United States: Elsevier Limited
  • Language: English
  • Identifier: ISSN: 0735-1097
    EISSN: 1558-3597
    DOI: 10.1016/j.jacc.2009.08.070
    PMID: 20152562
  • Source: GFMER Free Medical Journals
    MEDLINE
    Alma/SFX Local Collection
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