Lead Extraction in the Contemporary Setting: The LExICon Study. An Observational Retrospective Study of Consecutive Laser Lead Extractions

Oussama Wazni, Laurence M. Epstein, Roger Carrillo, Charles Love, Stuart W. Adler, David W. Riggio, Shahzad S. Karim, Jamil Bashir, Arnold J. Greenspon, John P. DiMarco, Joshua M. Cooper, John R. Onufer, Kenneth A. Ellenbogen, Stephen P. Kutalek, Sherri Dentry-Mabry, Carolyn M. Ervin, Bruce L. Wilkoff

Research output: Contribution to journalArticle

320 Citations (Scopus)

Abstract

Objectives: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients. Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices. Methods: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included. Results: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index <25 kg/m2 and low extraction volume centers. Procedural failure was higher in leads implanted for >10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index <25 kg/m2. Overall all-cause in-hospital mortality was 1.86%; 4.3% when associated with endocarditis, 7.9% when associated with endocarditis and diabetes, and 12.4% when associated with endocarditis and creatinine ≥2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine ≥2.0. Conclusions: Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m2. Centers with smaller case volumes tended to have a lower rate of successful extraction.

Original languageEnglish
Pages (from-to)579-586
Number of pages8
JournalJournal of the American College of Cardiology
Volume55
Issue number6
DOIs
StatePublished - Feb 9 2010
Externally publishedYes

Fingerprint

Observational Studies
Endocarditis
Lasers
Retrospective Studies
Body Mass Index
Hospital Mortality
Equipment and Supplies
Creatinine
Infection
Renal Insufficiency
Lead
Safety
Mortality

Keywords

  • cardiac implantable electronic devices
  • extraction
  • laser
  • leads

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lead Extraction in the Contemporary Setting : The LExICon Study. An Observational Retrospective Study of Consecutive Laser Lead Extractions. / Wazni, Oussama; Epstein, Laurence M.; Carrillo, Roger; Love, Charles; Adler, Stuart W.; Riggio, David W.; Karim, Shahzad S.; Bashir, Jamil; Greenspon, Arnold J.; DiMarco, John P.; Cooper, Joshua M.; Onufer, John R.; Ellenbogen, Kenneth A.; Kutalek, Stephen P.; Dentry-Mabry, Sherri; Ervin, Carolyn M.; Wilkoff, Bruce L.

In: Journal of the American College of Cardiology, Vol. 55, No. 6, 09.02.2010, p. 579-586.

Research output: Contribution to journalArticle

Wazni, O, Epstein, LM, Carrillo, R, Love, C, Adler, SW, Riggio, DW, Karim, SS, Bashir, J, Greenspon, AJ, DiMarco, JP, Cooper, JM, Onufer, JR, Ellenbogen, KA, Kutalek, SP, Dentry-Mabry, S, Ervin, CM & Wilkoff, BL 2010, 'Lead Extraction in the Contemporary Setting: The LExICon Study. An Observational Retrospective Study of Consecutive Laser Lead Extractions', Journal of the American College of Cardiology, vol. 55, no. 6, pp. 579-586. https://doi.org/10.1016/j.jacc.2009.08.070
Wazni, Oussama ; Epstein, Laurence M. ; Carrillo, Roger ; Love, Charles ; Adler, Stuart W. ; Riggio, David W. ; Karim, Shahzad S. ; Bashir, Jamil ; Greenspon, Arnold J. ; DiMarco, John P. ; Cooper, Joshua M. ; Onufer, John R. ; Ellenbogen, Kenneth A. ; Kutalek, Stephen P. ; Dentry-Mabry, Sherri ; Ervin, Carolyn M. ; Wilkoff, Bruce L. / Lead Extraction in the Contemporary Setting : The LExICon Study. An Observational Retrospective Study of Consecutive Laser Lead Extractions. In: Journal of the American College of Cardiology. 2010 ; Vol. 55, No. 6. pp. 579-586.
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abstract = "Objectives: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients. Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices. Methods: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included. Results: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5{\%} of the time, with a 97.7{\%} clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index <25 kg/m2 and low extraction volume centers. Procedural failure was higher in leads implanted for >10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4{\%}) including 4 deaths (0.28{\%}). Major adverse effects were associated with patients with a body mass index <25 kg/m2. Overall all-cause in-hospital mortality was 1.86{\%}; 4.3{\%} when associated with endocarditis, 7.9{\%} when associated with endocarditis and diabetes, and 12.4{\%} when associated with endocarditis and creatinine ≥2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine ≥2.0. Conclusions: Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m2. Centers with smaller case volumes tended to have a lower rate of successful extraction.",
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AU - Love, Charles

AU - Adler, Stuart W.

AU - Riggio, David W.

AU - Karim, Shahzad S.

AU - Bashir, Jamil

AU - Greenspon, Arnold J.

AU - DiMarco, John P.

AU - Cooper, Joshua M.

AU - Onufer, John R.

AU - Ellenbogen, Kenneth A.

AU - Kutalek, Stephen P.

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N2 - Objectives: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients. Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices. Methods: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included. Results: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index <25 kg/m2 and low extraction volume centers. Procedural failure was higher in leads implanted for >10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index <25 kg/m2. Overall all-cause in-hospital mortality was 1.86%; 4.3% when associated with endocarditis, 7.9% when associated with endocarditis and diabetes, and 12.4% when associated with endocarditis and creatinine ≥2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine ≥2.0. Conclusions: Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m2. Centers with smaller case volumes tended to have a lower rate of successful extraction.

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