Objective:To describe our experience on lead extraction in Hong Kong.Background:Pacing lead extraction is required when there is infection,lead fracture with protrudingfiagments and absence of venous access during lead replacement.Methods:We performedthe first lead extraction in Hong Kong using the Cook sheath on March 1995.Since 1996,Spectranetics laser sheath using Excimer Laser System(Model CVX-300)was used.Theprocedure was performed under general anesthesis(Cook sheath)or conscious sedation(Laserextraction).Results:Twenty patients with a total of 26 leads were extracted.The indicationsfor lead extraction were:I.Fracture retention wire of Aceufix lead(15 patients)2,Infectedpacing leads(4 patients).3.Venous access problem(1 patient).9 leads were extracted withthe Cook sheath,the remaining 17 leads by larer-assisted device.There were 20 atrial leadsand 6 ventricular leads from Telectrontics,Medtronic.Cordis and Intermedics,with thelongest irnplanted lead of 15 years.Snccessful extraction eas achieved in 24/26(93%)of leadsIn one patient,fracture of outer insulation of Accutix at the superior vena cava occurred afierusccessful removal of the lead from the atrium,and this requited venotomy for extraction.Failure of advancement of locking styler occurred in another patient with an uninfectedvetricular lead which was not extractde,There was no mortality nor any other majorcomplictaion,Re-implantation was performed at the same setting except for the 4 infectedcases Conelmslom:Lead extraction can be perfomned effectively and smfely with,either theCook or Lmser extraction method,the latter can be chieved without general anesthesia.Aslead extraction may be incteasingly used in the young patients to reduce the qumber ofhardwares inside the beart and for the purpose of schieving venous access,lends that areabandoned at the time of pacernaker change should be capped rather than cut to facilitate leadextraction in the futureA.
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