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(Circulation. 1999;100:516-525.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Initial Experience With Larger Laser Sheaths for the Removal of Transvenous Pacemaker and Implantable Defibrillator Leads

Laurence M. Epstein, MD; Charles L. Byrd, MD; Bruce L. Wilkoff, MD; Charles J. Love, MD; T. Duncan Sellers, MD; David L. Hayes, MD; Christopher Reiser, PhD

From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass; Broward General Medical Center, Fort Lauderdale, Fla; the Cleveland Clinic Foundation, Cleveland, Ohio; Ohio State University, Columbus, Ohio; Memorial Hospital, Colorado Springs, Colo; Mayo Clinic and Mayo Foundation, Rochester, Minn; and Spectranetics Corporation, Colorado Springs, Colo.

Correspondence to Laurence M. Epstein, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, Boston, MA 02215. E-mail lepstein{at}bidmc.harvard.edu

Background—In a previous randomized trial, the 12F laser sheath removed pacing leads via the implant vein more successfully than traditional mechanical tools alone. Two larger sizes of laser sheath, the 14F and 16F models, were developed to extract defibrillator leads and large-diameter pacing leads implanted for the chronic. These devices use pulsed ultraviolet laser light to core though fibrotic tissue grown over the lead body to free the lead from the vasculature. A mandatory prospective registry studied the safety and effectiveness profiles of the larger laser sheaths vis-à-vis the 12F laser sheath.

Methods and Results—In this study, 863 patients underwent extraction of 1285 leads at 52 sites. Patients treated with the 14F device tended to have older leads than the 12F population; the 16F population, which comprised mostly defibrillator patients, were younger, had younger leads, and were more often male than the 12F population. Clinical success (extracting the entire lead or the lead body minus the distal electrode) was observed in 91% to 92% of cases for all device sizes. The overall complication rate was 3.6%, with 0.8% perioperative mortality. Incidence of complications was independent of laser sheath size.

Conclusions—The 14F and 16F laser sheaths offer an extraction option for larger long-term transvenous pacemaker and defibrillator leads that is as safe and effective as the 12F laser sheath.

Key Words: heart-assist device • pacemakers • lasers • defibrillation

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