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Effectiveness of Excimer Laser‐Assisted Pacing and ICD Lead Extraction in Children and Young Adults
Author(s) -
MOAK JEFFREY P.,
FREEDENBERG VICKI,
RAMWELL CAROLYN,
SKEETE ALLISON
Publication year - 2006
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2006.00376.x
Subject(s) - medicine , stylet , transvenous pacing , lead (geology) , implantable cardioverter defibrillator , tamponade , surgery , subclavian vein , population , cardiology , catheter , environmental health , geomorphology , geology
Background: High capture thresholds, decreased electrical sensing, and lead fractures continue to be a problem in children undergoing transvenous pacing. The clinician must therefore decide at the time of pacing system revision to either abandon chronically implanted transvenous pacing leads or extract them.Methods: We report our experience using an excimer laser‐assisted (LA) strategy for removing chronically implanted pacing (36) and implantable cardioverter/defibrillator (ICD) (7) leads in children and young adults. The study population consisted of 25 patients, in whom 29 procedures were performed. The patients ranged in age from 8.4 to 39.9 years, median age was 13.9 years, at the time of the extraction procedure. In all procedures, a Spectranectics™ locking stylet and excimer laser sheath were used to assist in lead extraction.Results: Lead removal was complete for 39 (91%) leads, and partial for four leads. In two patients, the pacing lead tip was retained and in two, the ring electrode from a bipolar pacing lead was left in situ . All ICD leads were removed completely. Two major complications occurred—cardiac perforation and tamponade (1), and thrombosis of the left subclavian/innominate vein (1). LA extraction facilitated the implantation of new pacing or ICD leads in three patients with obstructed venous access.Conclusions: Removal of pacing and ICD leads using an excimer LA technique was highly successful. Lead removal was complete in 91%. The most common indication for lead removal in our study was lead fracture. Complications were few, but may be significant.