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LExICon: Laser lead extraction associated with low procedural complication rate
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Total in-hospital mortality rates among patients undergoing laser-assisted lead extraction were low, but device-related endocarditis and the presence of other comorbidities increased the risk for mortality.
Researchers for the LExICon study enrolled 1,449 consecutive patients who underwent transvenous laser-assisted lead extraction between January 2004 and December 2007. The researchers defined procedural success as either complete or partial removal of lead material from the vascular space and failure as “abandoning a significant length of lead after attempted removal.” The researchers considered clinical success to be the resolution of clinical indication for lead removal with the absence of major complications and control of pacing status. Clinicians attempted to extract 2,405 leads, of which 2,322 (96.5%) were completely removed. Infection was the most common indication for lead extraction (56.9%; n=825). Among those, 423 patients had device-related endocarditis and 402 had pocket infections. Venous stenosis or occlusion was noted in 65 (4.5%) patients, and pain at the device implant or lead insertion site was noted in 12 (0.8%) patients.
Results from a multivariate model suggested that BMI <25 was associated with failure to reach clinical success (P=.0128). The researchers reported 63 major adverse events in 58 patients (4.0%) and 27 minor adverse events in 26 patients (1.8%). Results from a multivariate model indicated that only patients with BMI <25 were more likely to experience a major adverse event related to the extraction procedure (P=.0132). A separate multivariate model suggested that patients with creatinine >2.0 mg/dL; diabetes; BMI <25; and infection were all at increased risk for death (P<.0001). The overall in-hospital all-cause mortality rate was 1.86% but was 4.3% when associated with device-related endocarditis; 7.9% when associated with endocarditis and diabetes; and 12.4% when associated with creatinine ≥2.0 mg/dL and endocarditis.
“Transvenous laser-assisted lead extraction is highly successful with a low procedural complication rate for a wide range of indications,” the researchers concluded. “Device-related infection was the most common indication for lead extraction, and both device-related endocarditis and pocket infections carry a substantial in-hospital mortality risk despite successful removal of the infected device and leads. Therefore, an increased emphasis must be placed on techniques that reduce the potential for device-related endocarditis.”
Wazni O. J Am Coll Cardiol. 2010;55:579-586.