Laser Lead Extraction in Patients with Venous Stenosis or Occlusion: System Upgrade or Revision Is Needed

Objectives: The approach to treat patients in need of system upgrade or revision suffering from venous occlusion or stenosis is a challenging procedure and ongoing issue.

Because venous occlusion may be asymptomatic for a long time contralateral implantation of a new device is performed most commonly when it comes to system upgrade. The aim of this study is to show the feasibility of laser lead extraction (LLE) for venous re-canalization followed by simultaneous ipsilateral re-implantation.

Methods: A retrospective study was conducted on 53 consecutive patients who underwent LLE for system upgrade (28.3%) or revision (71.7%) between January 2012 and August 2017. All patients with venous occlusion or severe stenosis were included. Clinical characteristics, device information and intra-procedural data were analyzed. Indications, outcomes and complications were classified in accordance with the Heart Rhythm Society Consensus Report on Transvenous Lead Extraction.

Results: Forty patients were male (75.5%) with a mean age of 64.8 ± 15.8 years. We treated 108 leads with a mean lead age of 105 ± 71 months. The rate of ICD leads was 35.2% and of dual coil leads was 11.1%. The mean procedural time was 118 ± 49 minutes with a mean fluoroscopy time of 15.9 ± 14.7 minutes. Clinical success and venous re-canalization followed by ipsilateral re-implantation was achieved in 51 cases (96.2%). No damage of the companion leads was observed. No intra-procedural death occurred.

Conclusion: Laser lead extraction is a save and feasible solution to manage system upgrade and revision in patients with venous occlusion or relevant stenosis avoiding contralateral implantation to prevent from further complications.