Comparison of non-laser and laser transvenous lead extraction: a systematic review and meta-analysis.

BACKGROUND: Transvenous lead extraction (TLE) is performed using non-laser and laser techniques with overall high efficacy and safety. Variation in outcomes between the two approaches does exist with limited comparative evidence in the literature.

AIM: We sought to compare non-laser and laser TLE in a meta-analysis.

METHODS: We searched Medline, Embase, Scopus, ClinicalTrials.gov and CENTRAL databases for TLE studies published between 1991-2021. From the included 68 studies, safety and efficacy data was carefully evaluated and extracted. Aggregated cases of outcomes were used to calculate odds ratio (OR) and pooled rates were synthesised from eligible studies, to compare non-laser and laser techniques. Subgroup comparison of rotational tool and laser extraction was also performed.

RESULTS: Non-laser in comparison to laser had lower procedural mortality (pooled rate 0% vs 0.1%, p < 0.01), major complications (pooled rate 0.7% vs 1.7%, p < 0.01) and superior vena cava (SVC) injury (pooled rate 0% vs 0.5%, p < 0.001), with higher complete success (pooled rate 96.5% vs 93.8%, p < 0.01). Non-laser comparatively to laser was more likely to achieve clinical (OR 2.16 [1.77-2.63], p < 0.01) and complete (OR 1.87 [1.69-2.08], p < 0.01) success, with a lower procedural mortality risk (OR 1.6 [1.02-2.5], p < 0.05). In the subgroup analysis, rotational tool compared to laser achieved greater complete success (pooled rate 97.4% vs 95%, p < 0.01) with lower SVC injury (pooled rate 0% vs 0.7%, p < 0.01).

CONCLUSION: Non-laser TLE is associated with a better safety and efficacy profile when compared to laser methods. There is a greater risk of SVC injury associated with laser sheath extraction.