Arrhythmia device lead extraction: Factors that necessitate laser assistance

BACKGROUND: The removal of pacemaker and implantable cardioverter defibrillator (ICD) leads has become a common procedure. The need for laser use has considerable implications regarding cost and expertise. It is not an option at till centres and introduces an element of risk to the procedure. Anticipation of the need for laser assistance may be of benefit to procedure planning. METHODS: Data on all patients undergoing lead extraction tit London Health Sciences Centre (London, Ontario) betwecn July 2001 and October 2006 were reviewed. Variables were assessed for independent association with the need for laser assistance. A prediction rule for laser use was created based on the multivariate model. RESULTS: From July 2001 to October 2006, 174 patients underwent lead extraction, with laser assistance required in 106 patients (68.8%). One hundred seven patients (69.5%) had pacemakers ant] the remainder had ICDS. The mean (+/- SD) device age was 7.6 +/- 5.7 years, with 1.9 +/- 0.9 leads requiring extraction. Clinical success was achieved in 152 patients (98.7%). Multivariate analysis revealed that laser use was less likely among men (OR 0.24, 95% Cl 0.069 to 0.84; P=0.026) and among septic patients (OR 0.25, 95% Cl 0.072 to 0.84; P-0.025), and more likely with ICDs than pacemakers (OR 4.40, 95% Cl 1.50 Act 12.91; P=0.0069) and with each additional year of device age (OR 1.46 per year, 95% Cl 1.26 to 1.70; P<0.0001). CONCLUSIONS: Laser assistance was required in 68.8% of cases, with clinical success in 98.7% of patients. Laser use was less likely among septic patients and men, and more likely with ICD leads and increasing time since lead implant. It was not possible to derive an accurate prediction rule for cases that would not need laser assistance. Therefore, it is prudent too ensure that a laser and appropriate infrastructure is available for lead extractions, and that the patient is aware of the possible need for laser assistance, along with the risks entailed.