Comparison of Electrocautery Platforms for Pulse Generator Replacement
Procedures
Abstract
Introduction: Lead damage can occur during cardiovascular implantable
electronic device (CIED) generator replacement procedures, resulting in
additional procedures and added costs. PlasmaBlade (PL) and PhotonBlade
(PH) are two commercially available insulated electrocautery devices
designed to reduce this risk. Objective: This study compared
complication rates of PL and PH in CIED generator replacement
procedures. Methods: This retrospective study analyzed transvenous CIED
generator replacements using PL or PH from 2017-2020. The primary
endpoint was lead damage. Secondary endpoints included rate of pocket
hematoma, superficial infection, and infections requiring device
removal. Results: A total of 209 patients were included for analysis,
including 86 procedures (188 leads) using PL and 123 procedures (266
leads) using PH. Lead insulation material consisted of 237 (52.2%)
silicone, 66 (14.5%) polyurethane, and 151 (33.3%) copolymer leads,
with no significant difference in frequency of insulation materials
(p=0.91). The rate of lead damage was low for both PL and PH (0 vs.
0.4%, p=0.59). There was no significant difference in pocket hematoma
(1.2% vs. 1.6%, p=0.43), superficial infection (1.2% vs. 0.8%,
p=0.49), or infection requiring device removal (1.2% vs. 0%, p=0.41).
The mean absolute change in lead impedance from pre- to post-procedure
was similar between PL and PH (72.3 ± 126.1 ohms vs. 60.6 ± 72.3 ohms,
p=0.10). Conclusions: There was a low rate of complications after CIED
replacement procedures, with no significant difference between the PL
and PH groups. A majority of leads with silicone insulation material may
have contributed to the low rate of lead damage.