Laser assistance for extraction of chronically implanted endocardial leads: Infectious versus noninfectious indications

Background: Powered sheaths, including Excimer laser sheaths, were introduced for the removal of transvenous pacing and defibrillator leads. The purpose of this study was to develop an algorithm to better predict which patients are likely to benefit from these devices. Methods: We reviewed 283 consecutive patients in whom a total of 500 leads (302 pacing and 198 defibrillator leads) were extracted over a 5-year period at our operative facilities. Laser assist was utilized whenever moderate traction failed. Results: In 128 patients, 203 leads were removed for noninfectious indication. In 155 patients, 297 leads for infectious indications, including sepsis 22% (111), pocket infection 23% (115), and erosion 14% (71). Laser assistance was required for 6% ± 5% (± 95% confidence interval) of septic leads, 51% ± 7% of leads associated with erosion or pocket infection and 60% ± 7% of noninfected leads (P = 0.001). Laser assistance was necessary more often for leads implanted >12 months (53% ± 5%) than 12 months or less (6% ± 5%) (P = 0.001) and for ventricular (52% ± 6%) compared to atrial (35% ± 7%) leads (P = 0.001). Conclusions: Chronically implanted leads (>12 months), especially noninfected leads and leads associated with erosion or pocket infection, should be referred for extraction with powered sheaths to ensure successful removal. However, leads that are associated with systemic sepsis can generally be removed without powered sheaths.