Laser extraction of infected pacemaker and ICD leads: early experience at Charleston Area Medical Center.

Infection of pacing and cardioverter defibrillator (ICD) implants is associated with high morbidity and mortality. To report a single center experience of extracted leads, we analyzed 42 (11 ICDs and 31 pacemakers) that had been extracted using laser sheath technology at Charleston Area Medical Center between November 2000 and September 2003. The indications for extractions were infection in 48% of the patients (n = 13) and lead malfunction in 52% (n = 14). In the infection group, 6 patients presented with endocarditis and 7 with pocket erosion and/or infection. Mean patient age was 69.5 years (range 46-96) and mean duration of lead implantation was 68.3 months (range 4-149). Complications with lead extraction occurred in 15% (n = 4); 1 patient had bleeding from right subclavian vein (RSCV); 1 patient had right ventricle perforation; and 2 patients developed cardiac tamponade. One patient with tamponade died despite emergency surgery. During a follow up of at least 8 months (range 8-42), 19% (n = 5) and 7% (n = 2) deaths occurred in the lead malfunction and infection groups respectively. This study shows that extraction is effective in treating pacemaker or ICD infections, but with a significant complication rate.