High success and safety of transvenous lead extraction using excimer laser sheaths in more than 1700 patients: a meta-analysis

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): Philips BACKGROUND: The excimer laser sheath is a commonly used advanced transvenous lead extraction (TLE) tool to aid the successful extraction of indwelling cardiac leads by ablating the tissues adhering to the leads. Many studies have reported favorable safety and efficacy results with leaser sheath assisted TLE in small patient groups. However, to date, there are no comprehensive large-scale studies using contemporary data to analyze the outcomes of excimer laser sheaths assisted TLE. PURPOSE: To assess the performance and safety of excimer laser sheath assisted TLE using meta-analysis of contemporary data. METHODS: A systematic literature search was performed to identify articles relevant for the evaluation of the safety and performance of the SLS II and GlideLight excimer laser sheaths in TLE procedures from April 1, 2016 to March 31, 2021. Safety outcomes included procedure-related deaths and major and minor complications. Performance outcomes included procedural success and clinical success rates achieved in TLE procedures as defined by 2017 HRS and 2018 EHRA consensus guidelines. A random-effects, inverse-variance-weighting meta-analysis using arsine square root transformation was performed to obtain the weighted average of evaluated outcomes. RESULTS: A total of 17 articles were identified and included for evaluation and data extraction, among which 6 were prospective studies and 11 were retrospective studies. The evaluated studies included 1,729 patients with 2,887 leads, among which 311 leads were extracted with the SLS II device, 1,688 were extracted using GlideLight, and the rest (n=888) involved both devices. Overall, 38.5% of leads were extracted due to infection. The most common lead type targeted for extraction were ICDs (47.9%). On average, each patient had 2.3 ± 0.3 leads and the lead dwell time was 7.9 ± 3.0 years. The TLE procedure successes rate per patient was 96.8% (1,440/1,505; 95% CI: [94.9%-98.2%]) and per lead 96.6% (1,447/1,501; 95% CI: [95.1%-97.7%]). The clinical success rate per patient was 98.3% (989/1,010, 95% CI: [97.4%-99.0%]). The weighted average of the procedure-related death rate was 0.08% (7/1,729, 95% CI: [0.00%, 0.34%]), comparable to the mortality rate reported in other studies on lead extraction safety. The most common complications were pericardial effusion or tamponade (n=21), hematoma (n=20) and cardiovascular injuries (n=18). CONCLUSION: TLE utilizing the excimer laser sheath has high success and low mortality rates and provides physicians with a valuable tool for safe and effective extraction of indwelling cardiac leads that require advanced extraction techniques. [Figure: see text] [Figure: see text]