Laser extraction is a safe and effective way to remove implanted pacemaker and defibrillator leads. Lead extraction can become complicated, because scar tissue will often form around the lead, binding it to the lining of the heart and blood vessels. In order to be removed, the scar tissue must be separated from the lead. Laser extraction uses ultraviolet rays to vaporize scar tissue surrounding the lead. This procedure is less likely to damage or tear the lining or heart and blood vessels, and is less time consuming and therefore less traumatic to the patient.

Older extraction techniques, such as placing acute/chronic tension (pulling) on leads, have frequently resulted in lead breakage and/or life-threatening complications. Often, the end result of these attempts was full-blown surgical extraction requiring thoracotomy and extensive intrathoracic vascular surgery. These procedures were associated with significant morbidity and mortality. More recently, a commercially available transvenous extraction system has been utilized. This system has a "locking stylet", which allows tension to be transmitted to the tip of the lead, and a series of telescoping sheaths, which shear away scar tissue encompassing the lead along its length. While this system offers a significant improvement over previously existing methods, success with the technique is at best modest. The shearing forces used in this procedures could result in significant complications.

The "Spectranetics Laser Sheath" uses a new approach to lead removal. This catheter sheath is advanced over the pacemaker or defibrillator lead; when scar tissue is encountered, the laser is activated and the scar tissue at the catheter tip is vaporized. Initial studies with the 12 F laser sheath catheter showed that complete lead removal was been successful in 94% of attempts as compared to 65% with the conventional system . In addition, the inability to pass the scar tissue binding site and lead breakage occurred less frequently in the laser-treated group. The availability of this technology offers significant potential advantages for patients requiring the extraction procedure.

Technologic changes are expanding the indications for pacemaker and defibrillator lead extraction. As device-based therapy is undergoing explosive growth with expanding indications in arrhythmia management, more devices are being implanted. Lead systems which fail or provide inadequate function may consume precious venous access or myocardial surface. Larger lead systems, such as those utilized for ICDs, are incompatible with multiple intravenous leads. Furthermore, abandoned leads have the potential to interfere with the function of newer lead systems by creating electrical chatter or energy shunting.

The safer and more effective technology of lead extraction also allows broader use of the procedure. As less invasive and safer extraction procedures became available, a risk-benefit analysis allows the physician to utilize lead extraction as a treatment option.

Level 1: Septicemia, Endocarditis, Lead Migration, Venous Access, Device Interference

Level 2: Vein Thrombosis, Severe Tricuspid Insufficiency, Pocket Infection, Chronic Draining Sinus, Lead damage needing replacement.