Document Detail


Laser lead extraction: is there a learning curve?
MedLine Citation:
PMID:  15733175     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Laser extraction of device leads offers an attractive alternative to countertraction and electrosurgical dissection sheath, potentially increasing efficacy and reducing complications. Wider adoption of this technology depends on relative ease of use. We report the experience of a new center to define the "learning curve." We performed 76 laser lead extractions in 75 patients (age 63 +/- 17 years, 59 male) from July 2001 to January 2004. Two experienced device implanters who were novice extractors underwent a 2-day site visit to a high volume extraction center for training. Lead extractions were performed in the operating room with immediate surgical backup. The indication for extraction was infection in 39 (systemic in 15), erosion or pain in 11, and lead related or debulking in 25. Complete removal was achieved in 139 of 145 leads (14 ICD, 131 pacemaker). Partial removal (<4 cm retained) was achieved in five leads (4%), and one lead could not be extracted. Complete success was 95% in the first third of patients, 94% in the second third, and 100% in the latter third. Fluoroscopy time fell from 19 +/- 22 minute in the first third of patients to 11 +/- 8 minute in the second third to 8 +/- 4 minute in the latter third (ANOVA P = 0.02). No major complications occurred. Local bleeding required minor left subclavian vein repair in two individuals. Symptomatic venous thrombosis occurred in 3 of the first 11 cases 1-21 days after extraction, but did not occur in the next 64 consecutive patients who received a 1-month anticoagulation regimen (27% vs 0%, P < 0.001). One patient developed venous thrombosis 3 weeks following cessation of warfarin therapy. Practice guidelines reasonably recommend appropriate training prior to independent performance of lead extraction. The current study suggests that experienced device implanters with appropriate operative backup taking a limited, but intensive training program can be safe and effective at lead extraction in a short time, in part a reflection of the improved technology.
Authors:
Nina Ghosh; Raymond Yee; George J Klein; Mackenzie Quantz; Richard J Novick; Allan C Skanes; Andrew D Krahn
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  28     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-02-28     Completed Date:  2005-06-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-4     Citation Subset:  IM    
Affiliation:
Division of Cardiology and Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Cardiology / education
Clinical Competence
Defibrillators, Implantable*
Device Removal / adverse effects,  methods*
Electrodes, Implanted* / adverse effects
Female
Humans
Lasers*
Male
Middle Aged
Pacemaker, Artificial*
Treatment Outcome
Comments/Corrections
Comment In:
Pacing Clin Electrophysiol. 2005 Mar;28(3):177-9   [PMID:  15733174 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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