Laser lead extraction of very old leads. Insights from the GermAn Laser Lead Extraction RegistrY (GALLERY)
Authors: Chung D , Burger H , Gessler N , Ghaffari N , Madej T , Ziaukas V , Reichenspurner H , Butter C , Willems S , Pecha S , Hakmi S 
Published: May 2024

Abstract

Background
Transvenous lead extraction (TLE) has become one of the most crucial therapeutic pillars in modern CIED management. Very old pacemaker and defibrillator leads are known to be risk factors for procedural complications in patients undergoing TLE.

Aim & Methods
Aim of this study was to analyze patients with very old leads undergoing TLE. We conducted a retrospective analysis of all patients in the GALLERY with at least one lead aged ≥10 years and compared them to a cohort of patients with leads aged &lt;10 years, in terms of baseline- and lead characteristics, as well as procedural outcomes and potential predictors of adverse events.

Results
We identified 858 patients with at least one lead aged ≥10 years (Group A) and 1666 patients with leads aged &lt;10 years (Group B). Patients in Group A were older (70.4±13.7 vs. 66.7±13.7; p&lt;0.001) and were less likely to exhibit highly reduced LVEF (18.5 vs. 30.0%, p&lt;0.001) or coronary artery disease (36.1 vs. 46.4%, p&lt;0.001), compared to Group B. The mean numbers of leads per patient were 2.5±1.1 and 2.4±1.0, respectively (p&lt;0.001) with median ages of the oldest indwelling lead of 161.5 [137-206.75] and 72.0 [48-94] months (p&lt;0.001). Patients in Group A had higher proportions of right-sided (47.7 vs. 25.8%, p&lt;0.001) and abandoned leads (41.3 vs. 23.4%, p&lt;0.001). Median procedural time was longer in Group A with 93.5 [63-145] vs. 75 [52-116] minutes (p&lt;0.001) with an increased necessity for additional tools for extraction (12.6 vs. 3.4%, p&lt;0.001). Overall (5.5 vs. 3.6%, p=0.03) and major complication rates (3.2 vs. 1.4%, p=0.005) were both higher in Group A. Patients in Group A were less likely to achieve complete procedural success rate (84.3 vs. 95.1%, p&lt;0.001) and had a higher rate for procedural failure (3.5 vs. 1.5%, p=0.002). There was no difference in procedure-related &lt;(0.7 vs. 0.5%, p=0.592) or all-cause mortality (3.5 vs. 3.2%, p=0.711) between groups. Multivariate analysis in Group A revealed the presence of abandoned leads (OR: 1.83, 95% CI: 1.0-3.4, p=0.049), female sex (OR: 2.15, 95% CI: 1.2-3.9, p=0.013) and systemic infection (OR:1.89, 95%CI: 1.0-3.5, p=0.039) as predictors for procedural complications. The use of additional extraction tools (OR:4.4, 95%CI:2.0-9.7, p&lt;0.001) and a BMI≥35 kg/m2 (OR:4.4, 95%CI:1.4-14.0, p=0.012) were identified as risk factors for procedural failure. Procedural complications (OR:5.2, 95%CI:2.0-13.7, p&lt;0.001) and systemic infection (OR:18.7, 95%CI: 5.6-62.9, p&gt;0.001) were highly predictive for all-cause mortality.

Conclusion
Patients with leads aged ≥10 years undergoing TLE suffer from more procedural complications, more often require additional extraction tools and have lower rates for complete procedural success, but do not show any differences in mortality, when compared to patients with leads aged &lt;10 years. The necessity of additional tools for extraction and a BMI≥35 kg/m2 were identified as predictors for procedural failure.