Abstract 11319: Success and Complication Rates in Cardiac Implantable Electronic Device (CIED) Laser Lead Extractions: A Systematic Review
Bibliographic record
Abstract
Introduction: Laser extraction sheaths are a valuable tool for complex CIED lead extractions. While there is evidence to suggest they have a higher complication rate than simple traction, there has been no systematic review of the literature regarding the success and complication rate associated with laser lead extractions. Objective: To conduct a systematic review investigating success and complication rates of CIED lead extractions using laser sheaths. Methods: A search was performed of studies published between January 1, 2000-August 29, 2019 indexed on Medline, EMBASE and Cochrane. Inclusion criteria were: (a) transvenous removal of ICD, pacemaker or CRT device leads, (b) Age≥18, (c) n>100 patients. Exclusion criteria were: (a) generator only procedures, (b) planned surgical extractions, (c) data prior to 2000. From these studies, we further selected papers containing laser lead extractions only, or laser-only cohorts, that reported on our outcomes. Outcomes: Complete procedural success, major and minor complications and procedure-related mortality. Results: 2307 abstracts were screened after de-duplication resulting in 164 papers. Of these papers, 11 were selected based on our inclusion criteria. All included studies follow the Heart Rhythm Society 2009 and 2017 or North American Society of Pacing and Electrophysiology 2000 guidelines criteria for extraction, major complications, minor complications and procedural success. Complete procedural success was reported by 9 studies which ranged from 89.26-100%; median 93.5% (IQR 89.26-97.56%). All 11 studies reported major complications which ranged between 1.08-6.25%; median 1.98% (IQR 1.50-3.57%). 8 reported minor complications which ranged from 1.09-5.69%; median 4.52% (IQR 3.80-4.94%). Procedure-related mortality was reported by 10 studies which ranged from 0-2.68%; median 0.10% (IQR 0.00-0.48%), while all-cause mortality during hospitalization was reported by 7 studies ranging from 0-2.17%; median 0.23% (IQR 0.00-1.18%). Conclusion: Laser lead extraction is associated with a high success rate of complete removal. Mortality rates due to procedure related factors are very low, however major and minor complications are not uncommon.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.045 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.012 |
| Bibliometrics | 0.013 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".