Abstract 1930: Laser Lead Extraction in Adults with Congenital Heart Disease
Background: Adults with congenital heart disease (ACHD) constitute a rapidly growing population in whom pacemakers and defibrillators are increasingly utilized. A corresponding rise in lead extraction procedures is anticipated. We assessed the safety and feasibility of laser lead extraction in ACHD.
Methods and Results: A total of 270 leads were targeted for laser extraction (Spectranectics, Colorado Springs, CO) at the Montreal Heart Institute in 175 patients between September 2000 and August 2005. In ACHD, 23 leads (5 atrial, 15 ventricular pacing, and 3 defibrillator leads) were targeted in 16 patients with the following diagnoses: TOF (N = 6), D-TGA with Mustard baffle (N = 2), L-TGA (N = 2), surgically repaired ASD (N = 2), surgically repaired LVOT obstruction (N = 2), and surgically repaired VSD (N = 2). Indications were infection in 44%, dysfunction in 25%, upgrade in 25%, and pain in 6%. Patients with ACHD were younger at the time of extraction (43.0 ± 13.5 versus 63.7 ± 14.7 years, P < 0.0001) but comparable with regards to gender, weight, indication for device implantation, indication for extraction, number of targeted leads, lead type, and side of implantation. An active fixation mechanism was present in a higher proportion of leads in ACHD (48% versus 31%, P < 0.0434). In patients with and without ACHD, lead age at extraction was 9.0 ± 5.2 versus 7.7 ± 5.2 years (P = 0.2713). Overall, 21 of 23 leads (91%) were successfully extracted in ACHD compared to 220 of 247 leads (89%) in patients without ACHD (P = 0.7405). One major complication (6.3%) occurred in a patient with ACHD (tricuspid valve laceration requiring surgical repair) compared to 5 major (3.0%) and 8 minor (5.0%) complications in patients without ACHD. Thus, presence of ACHD did not modulate procedural success [OR 1.3, 95% CI (0.3, 5.8), P = 0.7411] or complications [OR 1.0, 95% CI (0.2, 4.4), P = 0.9728]. However, the median procedural time was 27 minutes longer in patients with ACHD (127 versus 100 minutes, P = 0.0595).
Conclusion: In selected patients with ACHD, laser lead extraction may be performed with a safety and efficacy profile comparable to patients without ACHD.