# Laser vs rotational transvenous lead extraction: A systematic review and meta-analysis of procedural safety and efficacy outcomes

## TL;DR

This study compares laser and rotational methods for removing cardiac device leads and finds no significant difference in safety or effectiveness.

## Contribution

A meta-analysis comparing laser and rotational transvenous lead extraction methods for safety and efficacy outcomes.

## Key findings

- Laser and rotational TLEs had similar success rates and complication rates.
- Laser TLE had a higher risk of SVC laceration but not increased mortality.
- Both methods are equally safe and effective for lead extraction.

## Abstract

The rise in cardiac implantable electronic devices implantation has resulted in a concomitant rise in transvenous lead extractions (TLEs). Advanced extraction tools such as the excimer laser and mechanical rotational sheaths have improved acute procedural success when manual extraction fails. However, it is unclear how the laser sheath compares with the rotational sheath in safety and efficacy outcomes.

We aimed to compare the safety and efficacy of laser and rotational TLEs using a meta-analysis.

A systematic literature search was performed for studies involving the use of laser and/or rotational sheath published from 2008 onward. A random-effects model was used to compare outcome data including complete procedural success, clinical success, major complications, minor complications, and procedural death.

43 studies were included for meta-analysis, consisting of 13,189 patients and 20,103 extracted leads. The overall mean lead dwell time was 8.5 ± 12.7 years. There was no significant difference between laser- and rotational-assisted TLEs in complete procedural success (94% vs 94%, respectively; P = .92), major complications (1.9% vs 0.81%, respectively; P = .10), minor complications (5% vs 4%, respectively; P = .74), and procedural death (0.2% vs 0.04%, respectively; P = .14). Laser TLE had a 5.6-fold aggregated risk of SVC laceration compared with rotational TLE but this was not associated with an increased mortality.

Both laser and rotational TLEs are effective and safe. Our analysis suggests that there is no significant difference in safety profile between laser and rotational TLEs.