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Application of Excimer Laser for Percutaneous Extraction of Pacemaker and Defibrillator Leads: Experience from the Hunter Holmes McGuire Veterans Administration Medical Center and the Virginia Commonwealth University

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Lasers in Cardiovascular Interventions

Abstract

Over the last decades, the clinical need for managing the consequences of chronically implanted intravascular cardiac pacemaker or defibrillator leads has grown exponentially. Lead failure and new indications for an upgraded device therapy often requires new lead implantation in a limited central venous “real estate”. In addition, device implantation in patients with increasing comorbidities resulted in higher infection rates and cure in these cases is unlikely without complete system removal. While removal with simple traction of recently implanted leads is often sufficient, once significant fibrosis takes place around the lead (usually after 6 -12 months), use of special extraction tools often becomes necessary as traction may cause complications or incomplete lead removal. Among the numerous older and newer advanced lead management modalities, the most extensive clinical experience and supporting data from multicenter trials has come from the use of the excimer laser technology.

In this chapter, we discuss the main principles of lead extraction, including indications, perioperative management with particular focus on the laser lead removal technique and present outcome data from the Hunter Holmes McGuire VA Medical Center and the Virginia Commonwealth University.

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Author information

Authors and Affiliations

  1. Cardiac Electrophysiology Laboratory, Hunter Holmes McGuire VA Medical Center and Division of Cardiology, VCU Pauley Heart Center, Medical College of Virginia and VCU School of Medicine, 1201 Broad Rock Blvd. Room 111(J3), Richmond, VA, 23249, USA

    Karoly Kaszala MD, PhD, Alex Tan MD & Jose F. Huizar MD

  2. Division of Cardiology, VCU Pauley Heart Center, Medical College of Virginia and VCU School of Medicine, 1200E. Marshall Street, 3rd Floor, Electrophysiology Division, Room 3-223, Richmond, VA, 23219, USA

    Harsimran Saini MD, Yuhning L. Hu MD, Jayanthi Koneru MBBS & Kenneth A. Ellenbogen MD

  3. Cardiac Electrophysiology Laboratory, Hunter Holmes McGuirevVA Medical Center, 1201 Broad Rock Blvd. Room 111(J3), Richmond, VA, 23249, USA

    Jennifer Winfield BSN, RN

  4. VCU Pauley Heart Center, Medical College of Virginia and VCU School of Medicine, 1200E. Marshall Street, 3rd Floor, Electrophysiology Division, Room 3-223, Richmond, VA, 23219, USA

    Richard K. Shepard MD

Authors
  1. Karoly Kaszala MD, PhD
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  2. Alex Tan MD
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  3. Harsimran Saini MD
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  4. Yuhning L. Hu MD
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  5. Jennifer Winfield BSN, RN
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  6. Jayanthi Koneru MBBS
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  7. Richard K. Shepard MD
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  8. Kenneth A. Ellenbogen MD
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  9. Jose F. Huizar MD
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Corresponding author

Correspondence to Karoly Kaszala MD, PhD .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Charles George VA Medical Center, Asheville, North Carolina, USA

    On Topaz

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Kaszala, K. et al. (2015). Application of Excimer Laser for Percutaneous Extraction of Pacemaker and Defibrillator Leads: Experience from the Hunter Holmes McGuire Veterans Administration Medical Center and the Virginia Commonwealth University. In: Topaz, O. (eds) Lasers in Cardiovascular Interventions. Springer, London. https://doi.org/10.1007/978-1-4471-5220-0_19

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  • DOI: https://doi.org/10.1007/978-1-4471-5220-0_19

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5219-4

  • Online ISBN: 978-1-4471-5220-0

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