LASER-ASSISTED PACEMAKER/ICD LEAD EXTRACTION
What is Laser-Assisted Lead Extraction?
A laser lead extraction is the laser technique employed to remove a pacemaker or defibrillator wire or wires from inside the heart. A cardiac pacemaker or an implantable cardioverter defibrillator (ICD) is implanted in cardiac patients to regulate heart rate or heart rhythm. Sometimes, due to an infected device pocket, or a broken or malfunctioning wire, these leads need to be removed.
Following device implantation, the leads of the device get encapsulated by the scar tissue and attach tightly to the vascular endothelium of the vein. The longer the device remains inside the body, the tighter the attachment, making removal difficult.
Laser-assisted lead extraction is a safe and effective method to extract the leads in patients with chronically implanted cardiac pacemaker and defibrillator wires. This technique utilizes pulses of laser light at a wavelength of 308 nm to break the fibrous attachments without damaging other leads. During the procedure, an incision is made on the left side of the chest, usually close to the old device and the generator is removed and disconnected from the lead. For laser lead extraction, a special laser sheath is advanced through the targeted vein and over the lead. The sheath is connected to a laser that delivers energy to remove the scar tissue and detach the lead. The lead, laser and the sheath are removed at the end of the procedure. A new lead or a new pacemaker or ICD is then implanted immediately or at a later date. This technique uses cold, controlled laser energy which is absorbed only by the tissue lipids and proteins, and not by water. It vaporizes the targeted sheath without damaging the surrounding lead.
Laser-assisted lead extraction is thus a safer procedure with very few complications as compared to other extraction methods, such as simple manual traction, and use of locking stylets and outer sheath. It usually requires less time and is effective in most cases.