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

<h2>Abstract</h2><h3>Background</h3> The rise in cardiac implantable electronic devices implantation has resulted in a concomitant rise in transvenous lead extractions (TLE). 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 to the rotational sheath in safety and efficacy outcomes. <h3>Objective</h3> We aim to compare the safety and efficacy of laser and rotational TLE using a meta-analysis. <h3>Methods</h3> A systematic literature search was performed for studies involving the use of laser and/or rotational sheath published from 2008 onwards. A random effects model was used to compare outcome data including complete procedural success, clinical success, major complications, minor complications and procedural death. <h3>Results</h3> Forty-three 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 TLE in complete procedural success (94% vs 94% respectively, P=0.92), major complications (1.9% vs 0.81% respectively, P=0.10), minor complications (5% vs 4% respectively, P=0.74) and procedural death (0.2% vs 0.04% respectively, P=0.14). Laser TLE had a 5.6-fold aggregated risk of SVC laceration compared to rotational TLE but this was not associated with an increased mortality. <h3>Conclusion</h3> Both laser and rotational TLE are effective and safe. Our analysis suggests that there is no significant difference in safety profile between laser and rotational TLE.