Laser Lead Extraction for Patient Suffering with Permanent Pacemaker Infection and Subsequent Implantation of New System as Leadless Pacemaker at Cardiac Catheterization Lab, Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital

Abstract

Patient whom bradyarrhythmia originates from a sinus node dysfunction or conduction system abnormalities that either result in bradycardia with a heart rate of fewer than 40 beats per minute or a sinus pause of more than 3 seconds. The patient is recommended to implant the permanent pacemaker to preserve consequential symptoms such as syncope, According to 2018 ACC/AHA/HRS Guideline. Although the complications such as infection have been found in less than 5 percent, the severe conditions following this need to be concerned, for example, myocarditis. Therefore, an infected device, including generator and lead, require to be removed. However, the limitation of an adhesive device probably occurs due to a long attachment lead on the vessel wall, furthermore, results in complicated by using a conventional procedure. Thus, a laser extraction is suggested to remove the pacing lead from the adhesive area as the Class I indication according to 2018 European Heart Rhythm Association (EHRA) Practical Guideline. Following the device removal process, the physician considers reimplanting the novel device known as a leadless pacemaker. Implantable cardiac pacemaker places directly to the right ventricle without leads enter the heart and vessel. Consequently, it is possible to reduce the potential of infection from adhesive lead.