Initial experience with a laser sheath to extract chronic transvenous implantable cardioverter-defibrillator leads

The introduction of transvenous implantable cardiovertor-defibrillator (ICD) therapy has been a major advancement in the prevention of sudden cardiac death.(1) The reports of recently completed trials has led to expanded indications for, and most likely expanded usage of, ICD therapy.(2,3) Despite the relative ease of implantation and the impressive efficacy, ICD therapy is not without complications. Lead dislodgment and fracture as well as infection remain not uncommon problems.(4) In addition, ICD leads are significantly larger than traditional pacemaker leads, making lead abandonment more problematic. Given these: issues, and the expanding usage of ICD therapy, physicians will be faced more often with the difficult challenge of ICD lead extraction. Permanent pacemaker leads often become encapsulated in dense scar tissue making ex; traction difficult. Recently, the use of a laser sheath has been shown to be significantly more effective than traditional methods to remove chronic transvenous pacemaker leads.(5) In this report we present our initial experience with the use of a laser sheath to extract chronic transvenous ICD leads.