Kennergren C
Sahlgrenska University Hospital, Göteborg, Sweden.
Pacing Clin Electrophysiol. 1998 Jan;21(1 Pt 2):268-70. doi: 10.1111/j.1540-8159.1998.tb01102.x.
An Excimer Laser system for the extraction of permanent pacemaker leads has been developed by Spectranetics Inc. and Dr. Charles L. Byrd. The laser energy is emitted at the tip of a flexible, fiberoptic 12F sheath that permits the removal of leads with a max. outer diameter of 7.1F. The CVX-300 Excimer Laser source is a xenon chloride laser with an output of 308 nm not visible to the human eye. This cool cutting laser has an absorption depth of 0.06 mm, the energy being absorbed by proteins and lipids. In clinical practice this means that the fibrotic sheaths usually surrounding the leads can be cut without damaging the endothelial wall or the insulation of leads, due to these characteristics the sheath can, however, not pass over tines. For the freeing of lead tips, locking stylets and outer sheaths are combined to perform counter traction.
From 8/96 to 5/97 50 leads (38 atrial, 12 ventricular) from 45 patients (22 females, 23 males, mean age 65.1 years, range 32-94) were extracted using the Excimer Laser at our institution. Mean lead implantation time was 47.7 months (range 10.5-351.7). Indication for extraction was suspected J-wire fracture in 16 leads, prophylactic in 8 leads, infection in 12 leads, exit block in 4 leads and other reasons in 10 leads. Mean extraction time, excluding reimplantation, was 10 minutes (range 1-50). The objective of the procedure (normally complete lead removal) was accomplished in all cases but three. All intended lead replacements were successful. No complications occurred. All patients left the hospital in good condition, one patient died, within 30 days due to progressive heart failure.
Lead extraction with Excimer Laser seems to be a safe and efficacious procedure. However, due to the inherent risks appropriate training and experience are essential. If the initial promising results can be maintained, indications for the removal of permanent pacing leads may widen considerably.
Spectranetics公司和查尔斯·L·伯德博士研发了一种用于拔除永久性起搏器导线的准分子激光系统。激光能量从一根柔性光纤12F鞘管的尖端发射，该鞘管可用于拔除最大外径为7.1F的导线。CVX - 300准分子激光源是一台氯化氙激光，输出波长为308nm，人眼不可见。这种冷切割激光的吸收深度为0.06mm，能量被蛋白质和脂质吸收。在临床实践中，这意味着通常包裹在导线周围的纤维化鞘管可以被切割，而不会损伤内皮壁或导线绝缘层。然而，由于这些特性，鞘管无法越过电极头。为了松开导线尖端，将锁定芯杆和外部鞘管组合起来进行反向牵引。
从1996年8月至1997年5月，在我们机构使用准分子激光拔除了45例患者（22例女性，23例男性，平均年龄65.1岁，范围32 - 94岁）的50根导线（38根心房导线，12根心室导线）。平均导线植入时间为47.7个月（范围10.5 - 351.7个月）。拔除指征为：怀疑J形钢丝断裂16根导线，预防性拔除8根导线，感染12根导线，出口阻滞4根导线，其他原因10根导线。不包括重新植入的平均拔除时间为10分钟（范围1 - 50分钟）。除3例患者外，所有病例均达到手术目的（通常为完全拔除导线）。所有预期的导线更换均成功。未发生并发症。所有患者出院时情况良好，1例患者在30天内死于进行性心力衰竭。
准分子激光导线拔除术似乎是一种安全有效的手术。然而，由于存在固有风险，适当的培训和经验至关重要。如果能维持最初令人鼓舞的结果，永久性起搏导线拔除的指征可能会大幅拓宽。
