Tanawuttiwat Tanyanan, Gallego Daniel, Carrillo Roger G
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Pacing Clin Electrophysiol. 2014 Sep;37(9):1120-8. doi: 10.1111/pace.12406. Epub 2014 Apr 26.
A higher frequency Excimer laser sheath using an 80-Hz pulse repetitive rate was approved by the Food and Drug Administration in April 2012. We reported our initial clinical experience with a high-frequency Excimer laser sheath and compared it with lower-frequency laser sheaths which have been previously used.
In this single center, retrospective cohort study, we evaluated patients who underwent lead extraction from December 2008 to May 2013. Those who underwent lead removal without using a laser sheath or with approaches other than subclavian were excluded. Primary endpoints included total laser time, number of pulses, and complications. Data on clinical characteristics, lead type, indications, and outcomes were prospectively collected and analyzed.
A total of 427 patients were included in the study (72.6% male; age 67.9 ± 15.23 years). Lower frequency and higher frequency laser sheaths were used in 315 and 112 patients, respectively. A total of 821 leads were removed with 765 leads (93.2%) extracted using the Excimer laser sheath. Lead age was 5.71 ± 4.96 years. Complete extraction was seen in all patients. A higher-frequency laser sheath was associated with a lower laser time and a lower total number of laser pulses even after adjustments for the number of leads, type of leads, and lead age. In the higher frequency group, mortality rate was 0.9% and minor complication rate was 3.6%.
When compared with the lower-frequency laser sheath, the higher-frequency laser sheath requires less laser times and more efficient amount of pulses for lead extraction with comparable success rate. Due to the rarity of major and minor complications, no statistical significance was found between the two groups.
2012年4月，美国食品药品监督管理局批准了一种使用80赫兹脉冲重复频率的高频准分子激光鞘。我们报告了我们使用高频准分子激光鞘的初步临床经验，并将其与先前使用的低频激光鞘进行了比较。
在这项单中心回顾性队列研究中，我们评估了2008年12月至2013年5月期间接受导线拔除的患者。排除那些未使用激光鞘或采用锁骨下以外方法进行导线拔除的患者。主要终点包括总激光时间、脉冲数和并发症。前瞻性收集并分析了临床特征、导线类型、适应症和结果的数据。
共有427名患者纳入研究（男性占72.6%；年龄67.9±15.23岁）。分别有315例和112例患者使用了低频和高频激光鞘。共拔除了821根导线，其中765根（93.2%）使用准分子激光鞘拔除。导线使用年限为5.71±4.96年。所有患者均实现了完全拔除。即使在对导线数量、导线类型和导线使用年限进行调整后，高频激光鞘仍与较短的激光时间和较少的激光脉冲总数相关。在高频组中，死亡率为0.9%，轻微并发症发生率为3.6%。
与低频激光鞘相比，高频激光鞘在导线拔除时所需的激光时间更少，脉冲效率更高，成功率相当。由于严重和轻微并发症的发生率较低，两组之间未发现统计学差异。
