Laser assisted extraction of pacemaker and implantable defibrillator leads.

OBJECTIVE: To analyze the results of laser-assisted extraction of permanent pacemaker and defibrillator leads. METHODS: We operated upon 36 patients, whose mean age was 54.2 years, and extracted 56 leads. The reasons for extracting the leads were as follows: infection in 19 patients, elective replacement in 13, and other causes in 4 patients. The mean time of catheter placement was 7.5+/-5.5 years. Forty-seven leads were from pacemakers, and 9 were from defibrillators. Thirty-eight leads were in use, 14 had been abandoned in the pacemaker pocket, and 4 had been abandoned inside the venous system. RESULTS: We successfully extracted 54 catheters, obtaining a 96.4% rate of success and an 82.1% rate for complete extraction. The 2 unsuccessful cases were due to the presence of calcium in the trajectory of the lead. The mean duration of laser light application was 123.0+/-104.5 s, using 5,215.2+/-4,924.0 pulses, in a total of 24.4+/-24.2 cycles of application. Thirty-four leads were extracted from the myocardium with countertraction after complete progression of the laser sheath, 12 leads came loose during the progression of the laser sheath, and the remaining 10 were extracted with other maneuvers. One patient experienced cardiac tamponade after extraction of the defibrillator lead, requiring open emergency surgery. CONCLUSION: The use of the excimer laser allowed extraction of the leads with a 96% rate of success; it was not effective in 2 patients who had calcification on the lead. One patient (2.8%) had a complication that required cardiac surgery on an emergency basis.

[Pacemaker with mechanical sensors. Accumulated experience in long-term follow-up]. / Marcapassos dotados de sensor mecânico. Experiência acumulada em seguimento tardio.

PURPOSE: To evaluate the behavior of single chamber stimulation system, rate responsive with vibration sensing, taking into consideration the results of long term clinical follow-up. PATIENTS AND METHODS: From september 1986 to april 1989, 70 patients received pacemakers with vibration sensing. Sixty four patients (91.9%) implanted Activitrax I model and six (8.1%) Activitrax II. Thirty-one (44.3%) were men and the mean age was 51.2 years. Fifty-one patients (72.9%) had complete atrioventricular block, 11 (15.7%) sinus node dysfunction, one (1.4%) sinus node and atrioventricular disease, and one (1.4%) for therapeutic support of arrhythmia. The etiology of these dysfunctions were Chagas' disease in 31.4%, myocardiosclerosis in 35.7%, post-operative in 15.6%, post-av node fulguration in 5.8% and idiopathic in 11.5%. The group was submitted to clinic and electronic evaluation and laboratory examinations: echocardiogram, dynamic ECG, stress test and ergoespirometric test. The mean follow-up as 19.6 months. RESULTS: Clinic evaluations: decrease in congestive heart failure functional class in 86% of the patients. No recurrence of syncopes and no cardiac deaths. Echocardiogram: increase in ejection fraction in 42% of patients. Dynamic ECG: appropriate rate response in 94.3% of patients (good cronotropic response). Ergoespirometry: increase in oxygen consumption in 75% of studied cases, Electronic evaluation: absence of generator dysfunction; complications in 18% of cases, all corrected by reprogramation. CONCLUSION: The single chamber cardiac stimulation system with vibration sensing showed safety, efficacy and low rate of complications.