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Pearls of Wisdom for High-Risk Laser Lead Extractions: A Focused Review

Fermin, Lilibeth MD, MBA*; Gebhard, Ralf E. MD; Azarrafiy, Ryan BA; Carrillo, Roger MD, MBA, FHRS

doi: 10.1213/ANE.0000000000002540
Cardiovascular Anesthesiology: Narrative Review Article

Due to new indications and improved technology, the incidence of laser lead extraction (LLE) has significantly increased over the past years. While LLE has been well studied and proven to be safe and effective, only few studies are geared toward the anesthesiologist’s role during high-risk LLEs. This article utilized both a focused review and authors’ experience to investigate anesthetic protocols during LLEs. Through this review, we recommend best practices for the anesthesiologist including appropriate procedure location, onsite availability of a cardiac surgeon, availability of a cardiopulmonary bypass machine, and intraoperative use of echocardiography to detect and address potential complications during high-risk LLEs.

Supplemental Digital Content is available in the text.Published ahead of print October 5, 2017.

From the *Department of Anesthesiology, Cleveland Clinic Florida, Weston, Florida; and Department of Anesthesiology, Perioperative Medicine and Pain Management and Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.

Published ahead of print October 5, 2017.

Accepted for publication August 31, 2017.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Portions of this submitted manuscript were presented at the Society of Cardiovascular Anesthesiologists Annual Meeting PBLD section in San Diego, CA, April 2016.

Reprints will not be available from the authors.

Address correspondence to Lilibeth Fermin, MD, MBA, 2950 Cleveland Clinic Blvd, Weston, FL 33331. Address e-mail to

© 2018 International Anesthesia Research Society
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