Laser technology provides less invasive option for extraction when pacing device leads deteriorate or become infected.
Brigham and Women’s Hospital (BWH) electrophysiologists offer a safer, more effective catheter-based laser technique for removing infected or fractured transvenous cardiac pacing device leads. The last decade has seen an explosive growth in the use of cardiac pacing devices:
Over time, the leads for these devices may become infected or fractured and may need to be removed and replaced. In addition, as cardiac pacing technology evolves, physicians may wish to upgrade a patient’s existing device with a newer, more effective one.
“Cardiac pacing devices and implantable cardiac defibrillators have benefited millions of patients, but the leads have been the weak link in these therapies,” says Laurence M. Epstein, MD, Chief of the Cardiac Arrhythmia Service and Director of the Electrophysiology Pacing Laboratory at BWH.
Abandoned leads can interfere with new devices and conventional options for lead replacement can result in:
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The vein becoming occluded;
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Incomplete removal, serious complications, or conversion to an open surgical procedure with its attendant risks.
Laser lead extraction
In expert hands, laser lead extraction has about a 95 percent success rate, significantly higher than that for conventional percutaneous lead extraction systems. The extraction device consists of a sheath wrapped in laser fiberoptics that is advanced through the vein and over the lead. The clinician applies a controlled dose of laser energy to ablate any scar tissue and free the lead that is then pulled out through the sheath.
Due to the inherent risk and technical challenges of transvenous lead extractions, most physicians who implant devices are reluctant to perform lead extractions. BWH is a regional, national, and international referral center for this procedure.
Dr. Epstein was one of a handful of physicians nationwide to test the innovative laser device for lead extraction, and the results of that testing formed the basis for FDA-approval of a laser sheath. Under the direction of Dr. Epstein, BWH clinicians are now using this technique and have become leaders in the field of lead extraction, performing over 100 procedures per year.
“We offer a catheter-based laser technique for lead extraction that decreases the risk of trauma to the heart and blood vessels and increases the success of the procedure,” says Dr. Epstein.
As indications for pacing device implantation continue to expand, the need for safe, effective lead extraction will also continue to grow. Innovations including largerdiameter sheaths to accommodate larger leads have been shown to be safe and effective and will make laser lead extraction, in experienced hands, a safe and appropriate option for more patients.
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