Laser Assisted Lead Extraction
In the past, dealing with infected or dysfunctional transvenous pacing or defibrillator leads has been problematic due to the complexity, lack of availability and risk of lead extraction techniques. It is known that definitive management of device infection involves complete removal of all foreign body including the device, and the indwelling leads. Management of dysfunctional or displaced leads that are scarred in place has been handled by trying to squeeze new leads through the same access point or more creative methods of connecting leads placed through different sites. In young people especially, this can be problematic creating venous thrombosis and challenging issues with central venous access. Recently, a commonly used ICD pace/sense/defibrillator lead has proven prone to fracture and ultimate ICD malfunction making lead extraction a necessity.
There now exists a safe, reliable and available technique of lead removal that can solve problems involving infection, venous access challenges and the need to revise or replace dysfunctional transvenous leads. Laser lead extraction involves two critical technologies, a lead locking device that allows traction to be placed on the lead without distorting or unraveling it, and a laser sheath that safely lyses any connections between the lead and surrounding tissues.
Laser lead extraction needs to be performed with the availability of TEE and cardiac surgical intervention with a coordinated effort including anesthesia, surgical staff and the physician operator. Our Heart and Vascular Team has taken the initiative to establish a lead extraction program. We have demonstrated the success and safety of the technology with several patient experiences. It is exciting to offer this unique service to the people of northeastern Wisconsin.