Extraction of pacemaker and implantable cardioverter defibrillator leads: a single-centre study of electrosurgical and laser extraction

Both electrosurgical dissection (EDS) and laser tools are effective in the extraction of chronic implanted endovascular leads. It is unclear which is superior. We undertook a retrospective single-centre study to assess this.

In our institution from 2000 to 2004, all extractions requiring an ablative sheath were performed using the EDS system. In 2004, an excimer laser system was acquired, which became the first choice. Consecutive patients undergoing extraction requiring an ablative sheath (EDS or laser) were studied. From 2000 to 2007, 140 leads were extracted from 74 patients (EDS 31 and laser 43). Procedural success was non-significantly higher in the laser vs. the EDS group (95 vs. 87%). In the EDS group, one patient suffered tamponade requiring surgery; in the laser group, one patient suffered a significant pericardial effusion treated conservatively. There were no deaths. Procedure and fluoroscopy times were similar between groups. More patients were referred for primary surgical extraction in the EDS vs. the laser era (7 vs. 0, P = 0.003).

Lead extraction using an ablative sheath is safe and effective. In our small study, there were no significant differences between EDS and laser sheaths in terms of success, time, or safety.