Laser-assisted lead extraction: the European experience

Kennergren, Charles; Bucknall, Cliff; Butter, Christian; Charles, Richard G.; Fuhrer, Juerg; Grosfeld, M.J.W.; Tavernier, René; Morgado, T.B.; Mortensen, Peter Thomas; Paul, Vince; Richter, Péter; Schwartz, T.; Wellens, Francis

doi:10.1093/europace/eum098

Cited by 126 publications

(101 citation statements)

References 16 publications

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“…Periprocedural complication rates following TLR have ranged from 1% to 6.7% in smaller studies of high-volume centers. 3,11,[15][16][17][18][19][20][21] In the world survey of cardiac pacing and cardioverter-defibrillators, all 81 centers involved reported major complications in their experience: 63% of centers in <1% of patients, 27% in 1% to 2%, 7.5% in 2% to 5%, and 2.5% of centers in >5% of patients. Absence of death was stated by 54% of centers; 36% reported deaths in <0.5%; and 10% experienced an incidence of death in 0.5% to 2% of patients.…”

Section: Discussionmentioning

confidence: 99%

Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States

et al. 2015

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Background— Transvenous lead removal (TLR) has made significant progress with respect to innovation, efficacy, and safety. However, limited data exist regarding trends in use and adverse outcomes outside the centers of considerable experience for TLR. The aim of our study was to examine use patterns, frequency of adverse events, and influence of hospital volume on complications. Methods and Results— Using the Nationwide Inpatient Sample, we identified 91 890 TLR procedures. We investigated common complications including pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with TLR, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. We specifically assessed in-hospital death (2.2%), hemorrhage requiring transfusion (2.6%), vascular complications (2.0%), pericardial complications (1.4%), open heart surgery (0.2%), and postoperative respiratory failure (2.4%). Independent predictors of complications were female sex and device infections. Hospital volume was not independently associated with higher complications. There was a significant rise in overall complication rates over the study period. Conclusions— The overall complication rate in patients undergoing TLR was higher than previously reported. Female sex and device infections are associated with higher complications. Hospital volume was not associated with higher complication rates. The number of adverse events in the literature likely underestimates the actual number of complications associated with TLR.

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Section: Discussionmentioning

confidence: 99%

Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States

et al. 2015

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“…12,14 -16 In all of these studies, the average age of the patients undergoing extraction was 65 years (range, 62.8 -65 years). 12,[13][14][15][16] Clinical decisions regarding patients in the later extreme of life (aged Ն80 years) had to be based on extrapolations from these data.…”

Section: Discussionmentioning

confidence: 99%

Laser Lead Extraction in the Octogenarian Patient

Rodriguez

Garisto

Carrillo

2011

Circ: Arrhythmia and Electrophysiology

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Background-In the United States, patients aged Ͼ75 years are the most rapidly growing segment in the population, with an expected increase of 126% by 2050. These patients account for Ͼ70% of the pacemakers and up to two thirds of the implantable cardioverter-defibrillators implanted annually. Our aim was to explore the clinical outcomes of device complications in the octogenarian population. Methods and Results-We performed a retrospective chart review of 506 patients undergoing laser lead extraction from January 2004 to September 2009. This population was divided into the following 2 groups based solely on age: octogenarians and nonoctogenarians. These 2 groups were compared on the basis of several characteristics and clinical outcomes. There were 118 patients in the octogenarian group (78 men) and 388 in the nonoctogenarians group (301 men) aged 85Ϯ3.8 and 64.2Ϯ12.4 years, respectively. A total of 253 leads (atrial, 99; ventricular, 145; coronary sinus, 9) were removed from the patients in the octogenarian group, and 814 leads (atrial, 295; ventricular, 442; coronary sinus, 77) were removed from the patients in the nonoctogenarian group. The main indication for extraction for both groups was infection. The lead implant duration was 59.6Ϯ52.8 and 38.6Ϯ43.9 months for octogenarians and nonoctogenarians, respectively. There was no significant difference with respect to the proportion of minor (Pϭ0.65), major (Pϭ0.56), and total (Pϭ0.50) complications. Conclusions-Laser

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“…31 System extraction is associated with a small risk of major complications, particularly vascular lacerations causing haemothorax and death. 32,70,[79][80][81][82] Extraction-related mortality rates are 0.1-0.8 % in large experienced centres. 70,83 In one large, single-centre study, including more than 5,000 lead extractions, 43 % of which were due to infection, risk of major complications was 1.8 %, and minor complications 3.6 %.…”

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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Laser-assisted lead extraction: the European experience

Cited by 126 publications

References 16 publications

Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States

Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States

Laser Lead Extraction in the Octogenarian Patient

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

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