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Determinants of procedural outcome of chronically implanted pacemaker and defibrillator leads using the Excimer laser sheath

The extraction of chronic pacemaker and internal cardioverter defibrillator leads is performed for a number of reasons including chronic infection, lead dysfunction, and venous obstruction. Traditionally leads were removed by traction which is associated with a high incidence of failure and serious complications. This has led to the introduction of laser lead extraction (LLE) which is a safe and reliable method with a success rate of over 90%.1 We prospectively examined the procedural success and safety of LLE over a two year period in our institution. We also examined whether procedural outcome could be predicted by baseline variables.

All patients gave full written informed consent for extraction procedures. LLE was performed if simple traction had failed. Fluoroscopy was used to monitor all transvenous manoeuvres. LLE was performed using previously described techniques1 with a Spectranetics Model CVX-300 Excimer Laser System (Spectranetics, Colorado Springs, USA) in combination with a Spectranetic laser sheath and a Cook Byrd Dilator Sheath stylet (Cook Vascular, Leechburg, Pennsylvania, …