Initial Experience of Percutaneous Extraction of Infected Cardiac Implantable Electric Devices Using Excimer Laser

Background:The estimated incidence of infected cardiac implantable electric devices (CIED)has recently increased to 1% -2%.Prompt removal of infected devices improves survival rates.We describe our initial experience of lead extraction from infected devices using an excimer laser that was approved for this application in 2010. Methods and results:We retrospectively analyzed the characteristics,type of devices and leads,as well as indications and complications in 13 patients with CIED infection between 2011 and 2014 at our hospital. The clinical presentation comprised isolated pocket infection(n=12),lead endocarditis(n=3)and methicillinresistant Staphylococcus aureus-positive blood cultures.The patients had been implanted with a total of 29 leads(atrial,n=13;ventricular,n=16)for a median duration of 10.2±5.2 years.The procedure was successful in all patients,but two patients who developed recurrent infection required repeated removal of devices and an implant device from epicardial cardiac muscle.Acute cardiac tamponade occurred in one patient after ventricular lead extraction due to perforation of the right ventricle. This patient required an emergency thoracotomy,but was discharged one month after the procedure. Conclusion :Infected CIED leads can be quickly extracted using an excimer laser.Shinshu Med J 63 :103― 108, 2015 (Received for publication August 18,2014;accepted in revised form November 28,2014)