Central venous occlusion is not an obstacle to device upgrade with the assistance of laser extraction

Objective: To assess the efficacy and safety of laser-assisted lead extraction for upgrade of existing pacemakers and defibrillators in patients with central venous obstruction. Background: Implantable cardiac defibrillators and biventricular pacing have become the accepted therapeutic measures for patients with congestive heart failure. Many patients who ore candidates for device therapy, however, already have existing right ventricular leads and the presence of central venous obstruction. Upgrade of existing devices in these patients is a dilemma, which is increasingly encountered by device-implanting physicians. Laser-assisted extraction of existing leads can facilitate access for device upgrade and provide an alternative to lead abandonment and contralateral implant. Methods: We review our experience with laser-assisted lead extraction in patients, referred for upgrade of existing devices, who were found to have, or known to have, ipsilateral subclovian vein occlusion. Results: Over the past 3 years, 18 patients (13 men, 5 women; mean age 63.9 +/- 16 years) with subclavian vein occlusion underwent successful laser-assisted lead extraction (total 29 leads) and upgrade of existing leads to defibrillators and/or biventricular systems. Mean implant duration prior to extraction was 70.8 +/- 43.5 (11-192) months. Cannulation of the coronary sinus and placement of a transvenous left ventricular lead were achieved in all 13 patients in whom it was attempted. No complications occurred. Conclusions: Laser-assisted lead extraction is a safe and effective approach, allowing for ipsilateral device upgrade in patients with existing devices and central venous obstruction.