Seven Years’ Experience in Laser Lead Extraction in Lead Endocarditis

Objectives: Lead endocarditis is a challenging disease because extraction of long time cardiac leads can be demanding. We investigated feasibility and success of transvenous laser lead extraction with a Spectranetics SLS II 40 Hz laser sheath in lead endocarditis.

Methods: From May 2011 to April 2018, 28 patients (mean age 71.8 ± 8 years [57–87]; 23 males) underwent laser lead extraction for lead endocarditis. Two patients were operated under emergency conditions in septic shock. Indication for lead extraction was systemic infection with echocardiographic proven lead vegetations in all patients.

Eleven patients had additional valvular endocarditis (tricuspid valve n = 8, mitral valve n = 2, and aortic valve n = 1). Four patients with persisting tricuspid valve endocarditis after lead extraction were treated operatively within an interval of a few days to 4 weeks (valve replacement n = 3; valve repair n =1). The remaining patients were treated conservatively with intravenous antibiotic therapy for 6 weeks according to guidelines.

Mean time interval from initial lead implantation until extraction was 7.8 years (1–20 years). Mean number of extracted leads was 2.4 (1–6). Intraoperatively, in eight patients, an epimyocardial lead was implanted as backup due to complete heart block.

Results: Complete procedural success rate, defined as extraction of complete leads, was 96.4% (27 of 28). One patient had to be converted to open surgery because of previous lead manipulation resulting in impossibility to place the extraction tool. Major intraoperative complication rate was low with 3.6% (1 of 28). One patient developed pericardial tamponade due to injury of the superior vena cava and needed exploration for bleeding. There was no intraoperative mortality. The 30-day mortality was 21% (6 of 28), including 1 patient who was operated under emergency conditions (mean age 67 ± 7 years). Causes of death were septic shock (n = 5) and intracranial bleeding (n = 1).

Conclusion: Laser lead extraction in the presence of lead endocarditis allows for high safety and efficacy of removal of longly implanted leads. Anyhow, lead endocarditis is a serious disease, which results in relevant mortality even after the removal of the infective focus.