Pacing lead extraction using an excimer laser sheath under general anesthesia

An excimer laser sheath has recently been used for extraction of pacing and ICD leads. By using this technique, leads are removed more easily and it has to take a shorter time to extract leads. Although lead extraction with this method can cause fatal complications such as large vessel injury, little has been reported regarding anesthetic management during the lead extraction. We experienced two cases of pacing lead extraction using an excimer laser sheath under general anesthesia. The procedures were mainly performed by cardiologists in the operating theater. A wide area was prepared with sterile drapes as for cardiac surgery with cardiovascular surgeons standing by. Vascular access catheters were placed in the right femoral artery as well as vein, and in the right internal jugular vein so that immediate PCPS introduction could be performed in case of sudden hemodynamic collapse by massive bleeding. In the first case, lead extraction was completed without any complication, but in the second case sternotomy was performed by cardiac surgeons for safe separation of leads from vessels. There were also no bleeding episodes in the second case. Preparation for bleeding and cooperation among cardiologists, cardiovascular surgeons, medical engineers and anesthesiologists are necessary from the safety point of view of this procedure under general anesthesia.