Clinical study of the laser sheath for lead extraction: The total experience in the United States

Charles L. Byrd, Bruce L. Wilkoff, Charles Love, T. Duncan Sellers, Christopher Reiser

Research output: Contribution to journalArticle

Abstract

The laser sheath uses optical fibers, delivering pulsed ultraviolet excimer laser light, to vaporize fibrotic tissue binding intravenous cardiac leads to the vein or heart wall during lead extraction from the implant vein. The total investigational experience with laser sheaths is reported. During the period from October 1995 to December 1999, 2, 561 pacing and defibrillator leads were treated in 1, 684 patients at 89 sites in the United States with three sizes of laser sheath. Endpoints were complete removal of the lead, partial removal (leaving the tip behind), or failure (abandoning the lead, onset of complications, change to transfemoral or transatrial approach). Minimal follow-up at 30 days was recorded. Of the leads, 90% were completely removed, 3% were partially removed, and the balance were failures. Major perioperative complications (tamponade, hemothorax, pulmonary embolism, lead migration, and death) were observed in 1.9% of patients with in hospital death in 13 (0.8%). Minor complications were seen in an additional 1.4% of patients. Multivariate analysis showed that implant duration was the only preoperative independent predictor o f failure; female sex was the only multivariate predictor of complications. Success and complications were not dependent on laser sheath size. At follow-up, various extraction related complications were observed in 2% of patients. The learning curve showed a trend toward fewer complications with experience. Lead extraction with the laser sheath can be safely practiced with high success rates. Success is independent of laser sheath size. Major complications can be expected in < 2% of patients, and occur more often during an investigator's early experience.

Original languageEnglish (US)
Pages (from-to)804-808
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume25
Issue number5
StatePublished - Jan 1 2002
Externally publishedYes

Fingerprint

Lasers
Veins
Hemothorax
Optical Fibers
Excimer Lasers
Defibrillators
Learning Curve
Pulmonary Embolism
Lead
Clinical Studies
Multivariate Analysis
Research Personnel
Light

Keywords

  • Defibrillator lead
  • Lead removal
  • Pacing lead
  • Ultraviolet

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical study of the laser sheath for lead extraction : The total experience in the United States. / Byrd, Charles L.; Wilkoff, Bruce L.; Love, Charles; Sellers, T. Duncan; Reiser, Christopher.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 25, No. 5, 01.01.2002, p. 804-808.

Research output: Contribution to journalArticle

Byrd, Charles L. ; Wilkoff, Bruce L. ; Love, Charles ; Sellers, T. Duncan ; Reiser, Christopher. / Clinical study of the laser sheath for lead extraction : The total experience in the United States. In: PACE - Pacing and Clinical Electrophysiology. 2002 ; Vol. 25, No. 5. pp. 804-808.
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abstract = "The laser sheath uses optical fibers, delivering pulsed ultraviolet excimer laser light, to vaporize fibrotic tissue binding intravenous cardiac leads to the vein or heart wall during lead extraction from the implant vein. The total investigational experience with laser sheaths is reported. During the period from October 1995 to December 1999, 2, 561 pacing and defibrillator leads were treated in 1, 684 patients at 89 sites in the United States with three sizes of laser sheath. Endpoints were complete removal of the lead, partial removal (leaving the tip behind), or failure (abandoning the lead, onset of complications, change to transfemoral or transatrial approach). Minimal follow-up at 30 days was recorded. Of the leads, 90{\%} were completely removed, 3{\%} were partially removed, and the balance were failures. Major perioperative complications (tamponade, hemothorax, pulmonary embolism, lead migration, and death) were observed in 1.9{\%} of patients with in hospital death in 13 (0.8{\%}). Minor complications were seen in an additional 1.4{\%} of patients. Multivariate analysis showed that implant duration was the only preoperative independent predictor o f failure; female sex was the only multivariate predictor of complications. Success and complications were not dependent on laser sheath size. At follow-up, various extraction related complications were observed in 2{\%} of patients. The learning curve showed a trend toward fewer complications with experience. Lead extraction with the laser sheath can be safely practiced with high success rates. Success is independent of laser sheath size. Major complications can be expected in < 2{\%} of patients, and occur more often during an investigator's early experience.",
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