Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction

Manav Sohal; Steven Williams; Majid Akhtar; Amit Shah; Zhong Chen; Matthew Wright; Mark O'Neill; Nik Patel; Shoaib Hamid; Michael Cooklin; Cliff Bucknall; Julian Bostock; Jaswinder Gill; Christopher Aldo Rinaldi

doi:10.1093/europace/eut163

Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction

Manav Sohal^*, Steven Williams, Majid Akhtar, Amit Shah, Zhong Chen, Matthew Wright, Mark O'Neill, Nik Patel, Shoaib Hamid, Michael Cooklin, Cliff Bucknall, Julian Bostock, Jaswinder Gill, Christopher Aldo Rinaldi

^*Corresponding author for this work

GSTT Guy's and St Thomas' NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

46 Citations (Scopus)

Abstract

Aims: The number of procedures involving upgrade or revision of cardiac implantable electronic devices (CIEDs) is increasing and the risks of adding additional leads are significant. Central venous occlusion in patients with pre-existing devices is often asymptomatic and optimal management of such patients in need of device revision/upgrade is not clear. We sought to assess our use of laser lead extraction in overcoming venous obstruction.

Methods and results: Patients in need of device upgrade/revision underwent pre-procedure venography to assess venous patency. In patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire, laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted. Data were recorded on a dedicated database and patient outcomes were assessed. Between July 2004 and April 2012, laser lead extractions were performed in 71 patients scheduled for device upgrade/revision who had occluded or functionally obstructed venous anatomy. New leads were successfully implanted across the obstruction in 67 (94%) cases. There were two major complications (infection) and four minor complications with no peri-procedural mortality. Device follow-up was satisfactory in 65 (92%) cases with mean follow-up up to 26 +/- 19 months.

Conclusion: Laser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of CIED revision or upgrade.

Original language	English
Pages (from-to)	81-87
Number of pages	7
Journal	EUROPACE
Volume	16
Issue number	1
DOIs	https://doi.org/10.1093/europace/eut163
Publication status	Published - Jan 2014

Keywords

Laser lead extraction
Venous obstruction
Pacemaker
Implantable cardiac defibrillator
Cardiac resynchronization therapy
CARDIOVERTER-DEFIBRILLATOR LEADS
RESYNCHRONIZATION THERAPY
PACING LEADS
PACEMAKER
SHEATH
EXPERIENCE
THROMBOSIS
OCCLUSION
INSERTION

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Sohal, M., Williams, S., Akhtar, M., Shah, A., Chen, Z., Wright, M., O'Neill, M., Patel, N., Hamid, S., Cooklin, M., Bucknall, C., Bostock, J., Gill, J., & Rinaldi, C. A. (2014). Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction. EUROPACE, 16(1), 81-87. https://doi.org/10.1093/europace/eut163

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title = "Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction",

abstract = "Aims: The number of procedures involving upgrade or revision of cardiac implantable electronic devices (CIEDs) is increasing and the risks of adding additional leads are significant. Central venous occlusion in patients with pre-existing devices is often asymptomatic and optimal management of such patients in need of device revision/upgrade is not clear. We sought to assess our use of laser lead extraction in overcoming venous obstruction. Methods and results: Patients in need of device upgrade/revision underwent pre-procedure venography to assess venous patency. In patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire, laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted. Data were recorded on a dedicated database and patient outcomes were assessed. Between July 2004 and April 2012, laser lead extractions were performed in 71 patients scheduled for device upgrade/revision who had occluded or functionally obstructed venous anatomy. New leads were successfully implanted across the obstruction in 67 (94%) cases. There were two major complications (infection) and four minor complications with no peri-procedural mortality. Device follow-up was satisfactory in 65 (92%) cases with mean follow-up up to 26 +/- 19 months. Conclusion: Laser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of CIED revision or upgrade.",

keywords = "Laser lead extraction, Venous obstruction, Pacemaker, Implantable cardiac defibrillator, Cardiac resynchronization therapy, CARDIOVERTER-DEFIBRILLATOR LEADS, RESYNCHRONIZATION THERAPY, PACING LEADS, PACEMAKER, SHEATH, EXPERIENCE, THROMBOSIS, OCCLUSION, INSERTION",

author = "Manav Sohal and Steven Williams and Majid Akhtar and Amit Shah and Zhong Chen and Matthew Wright and Mark O'Neill and Nik Patel and Shoaib Hamid and Michael Cooklin and Cliff Bucknall and Julian Bostock and Jaswinder Gill and Rinaldi, {Christopher Aldo}",

year = "2014",

month = jan,

doi = "10.1093/europace/eut163",

language = "English",

volume = "16",

pages = "81--87",

journal = "EUROPACE",

issn = "1099-5129",

publisher = "Oxford University Press (OUP)",

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Sohal, M , Williams, S, Akhtar, M, Shah, A, Chen, Z , Wright, M , O'Neill, M, Patel, N, Hamid, S, Cooklin, M, Bucknall, C, Bostock, J, Gill, J & Rinaldi, CA 2014, 'Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction', EUROPACE, vol. 16, no. 1, pp. 81-87. https://doi.org/10.1093/europace/eut163

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T1 - Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction

AU - Sohal, Manav

AU - Williams, Steven

AU - Akhtar, Majid

AU - Shah, Amit

AU - Chen, Zhong

AU - Wright, Matthew

AU - O'Neill, Mark

AU - Patel, Nik

AU - Hamid, Shoaib

AU - Cooklin, Michael

AU - Bucknall, Cliff

AU - Bostock, Julian

AU - Gill, Jaswinder

AU - Rinaldi, Christopher Aldo

PY - 2014/1

Y1 - 2014/1

N2 - Aims: The number of procedures involving upgrade or revision of cardiac implantable electronic devices (CIEDs) is increasing and the risks of adding additional leads are significant. Central venous occlusion in patients with pre-existing devices is often asymptomatic and optimal management of such patients in need of device revision/upgrade is not clear. We sought to assess our use of laser lead extraction in overcoming venous obstruction. Methods and results: Patients in need of device upgrade/revision underwent pre-procedure venography to assess venous patency. In patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire, laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted. Data were recorded on a dedicated database and patient outcomes were assessed. Between July 2004 and April 2012, laser lead extractions were performed in 71 patients scheduled for device upgrade/revision who had occluded or functionally obstructed venous anatomy. New leads were successfully implanted across the obstruction in 67 (94%) cases. There were two major complications (infection) and four minor complications with no peri-procedural mortality. Device follow-up was satisfactory in 65 (92%) cases with mean follow-up up to 26 +/- 19 months. Conclusion: Laser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of CIED revision or upgrade.

AB - Aims: The number of procedures involving upgrade or revision of cardiac implantable electronic devices (CIEDs) is increasing and the risks of adding additional leads are significant. Central venous occlusion in patients with pre-existing devices is often asymptomatic and optimal management of such patients in need of device revision/upgrade is not clear. We sought to assess our use of laser lead extraction in overcoming venous obstruction. Methods and results: Patients in need of device upgrade/revision underwent pre-procedure venography to assess venous patency. In patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire, laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted. Data were recorded on a dedicated database and patient outcomes were assessed. Between July 2004 and April 2012, laser lead extractions were performed in 71 patients scheduled for device upgrade/revision who had occluded or functionally obstructed venous anatomy. New leads were successfully implanted across the obstruction in 67 (94%) cases. There were two major complications (infection) and four minor complications with no peri-procedural mortality. Device follow-up was satisfactory in 65 (92%) cases with mean follow-up up to 26 +/- 19 months. Conclusion: Laser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of CIED revision or upgrade.

KW - Laser lead extraction

KW - Venous obstruction

KW - Pacemaker

KW - Implantable cardiac defibrillator

KW - Cardiac resynchronization therapy

KW - CARDIOVERTER-DEFIBRILLATOR LEADS

KW - RESYNCHRONIZATION THERAPY

KW - PACING LEADS

KW - PACEMAKER

KW - SHEATH

KW - EXPERIENCE

KW - THROMBOSIS

KW - OCCLUSION

KW - INSERTION

U2 - 10.1093/europace/eut163

DO - 10.1093/europace/eut163

M3 - Article

SN - 1099-5129

VL - 16

SP - 81

EP - 87

JO - EUROPACE

JF - EUROPACE

IS - 1

ER -

Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction

Abstract

Keywords

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