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Meta-Analysis
. 2023 Nov 2;25(11):euad316.
doi: 10.1093/europace/euad316.

Comparison of non-laser and laser transvenous lead extraction: a systematic review and meta-analysis

Zaki Akhtar  1 , Christos Kontogiannis  1 , Georgios Georgiopoulos  2   3 , Christoph T Starck  4 , Lisa W M Leung  1 , Sun Y Lee  5 , Byron K Lee  6 , Sreenivasa R K Seshasai  1 , Manav Sohal  1 , Mark M Gallagher  1
Affiliations
Meta-Analysis

Comparison of non-laser and laser transvenous lead extraction: a systematic review and meta-analysis

Zaki Akhtar et al. Europace. .

Abstract

Aims: Transvenous lead extraction (TLE) is performed using non-laser and laser techniques with overall high efficacy and safety. Variation in outcomes between the two approaches does exist with limited comparative evidence in the literature. We sought to compare non-laser and laser TLE in a meta-analysis.

Methods and results: We searched Medline, Embase, Scopus, ClinicalTrials.gov, and CENTRAL databases for TLE studies published between 1991 and 2021. From the included 68 studies, safety and efficacy data were carefully evaluated and extracted. Aggregated cases of outcomes were used to calculate odds ratio (OR), and pooled rates were synthesized from eligible studies to compare non-laser and laser techniques. Subgroup comparison of rotational tool and laser extraction was also performed. Non-laser in comparison with laser had lower procedural mortality (pooled rate 0% vs. 0.1%, P < 0.01), major complications (pooled rate 0.7% vs. 1.7%, P < 0.01), and superior vena cava (SVC) injury (pooled rate 0% vs. 0.5%, P < 0.001), with higher complete success (pooled rate 96.5% vs. 93.8%, P < 0.01). Non-laser comparatively to laser was more likely to achieve clinical [OR 2.16 (1.77-2.63), P < 0.01] and complete [OR 1.87 (1.69-2.08), P < 0.01] success, with a lower procedural mortality risk [OR 1.6 (1.02-2.5), P < 0.05]. In the subgroup analysis, rotational tool compared with laser achieved greater complete success (pooled rate 97.4% vs. 95%, P < 0.01) with lower SVC injury (pooled rate 0% vs. 0.7%, P < 0.01).

Conclusion: Non-laser TLE is associated with a better safety and efficacy profile when compared with laser methods. There is a greater risk of SVC injury associated with laser sheath extraction.

Keywords: Laser lead extraction; Lead extraction; Non-laser lead extraction; Rotational lead extraction; Transvenous lead extraction.

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Conflict of interest statement

Conflict of interest: M.G. has received research funding from Attune Medical and workshop fee from Cook Medical and has acted as a consultant and a paid speaker for Biosense Webster, Cook Medical, and Adagio. C.T.S. has received consulting fees and travel expenses from Medtronic; consulting fees and research support from Biotronik; research support from Abbott; workshop fees, consulting fees, educational grants, and research support from Cook Medical; consulting fees from Spectranetics/Philipps; and consulting fees from AngioDynamics. M.S. has received research funding from Abbott and workshop fee from Cook Medical. Z.A. has received a workshop fee from Cook Medical. All remainder authors have declared no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Funnel plots for publication bias. For the two main outcomes of efficacy and safety [successful extraction per patient (A) and occurrence of major complications (B)], we did not find evidence of major asymmetry in funnel plots or small-study effect (P > 0.05 for both Egger and Begg’s test in both endpoints). Circles represent individual studies of the meta-analysis and the vertical line the pooled estimate of the rate of (A) complete success per patient (B) major complications.
Figure 2
Figure 2
Flow chart of study identification and inclusion.
Figure 3
Figure 3
Forest plot illustrating the rate of major complications for laser and non-laser techniques. The OR corresponds to comparison of non-laser to laser techniques. CI, confidence interval; OR, odds ratio.
Figure 4
Figure 4
Forest plots illustrating the rate of clinical success (per patient) using non-laser and laser techniques. The OR corresponds to comparison of non-laser to laser techniques. CI, confidence interval; OR, odds ratio.
Figure 5
Figure 5
Forest plots illustrating the rate of complete success (per lead) using non-laser and laser techniques. The OR corresponds to comparison of non-laser to laser techniques. CI, confidence interval; OR, odds ratio.
Figure 6
Figure 6
Bubble plots with random-effects meta-regression line for the association of lead age with the rate of (A) successful extraction and (B) major complications per technique (non-laser and laser) (P > 0.05). Bubble size is proportional to the size of each individual study.
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Comment in

References

    1. Bongiorni MG, Burri H, Deharo JC, Starck C, Kennergren C, Saghy Let al. 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. Europace 2018;20:1217. - PubMed
    1. Raatikainen MJP, Arnar DO, Merkely B, Nielsen JC, Hindricks G, Heidbuchel Het al. A decade of information on the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European society of cardiology countries: 2017 report from the European Heart Rhythm Association. Europace 2017;19:ii1–90. - PubMed
    1. Starck CT, Gonzalez E, Al-Razzo O, Mazzone P, Delnoy PP, Breitenstein Aet al. Results of the Patient-Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques. Europace 2020;22:1103–10. - PMC - PubMed
    1. Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf Ret al. Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol 1999;33:1671–6. - PubMed
    1. Wazni O, Epstein LM, Carrillo RG, Love C, Adler SW, Riggio DWet al. Lead extraction in the contemporary setting: the LExICon Study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 2010 Feb;55:579–86. - PubMed

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