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

Autor:	Sohal M; Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, London SE1 7EH, UK., 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
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2014 Jan; Vol. 16 (1), pp. 81-7. Date of Electronic Publication: 2013 Jun 20.
DOI:	10.1093/europace/eut163
Abstrakt:	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.
Databáze:	MEDLINE
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