Safety and efficacy of excimer laser powered lead extractions in obese patients: a GALLERY subgroup analysis
Authors: Schenker N , Chung D , Burger H , Kaiser L , Osswald B , Baersch V , Naegele H , Knaut M , Reichenspurner H , Gessler N , Willems S , Butter C , Pecha S , Hakmi S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Both, the prevalence of obesity and incidence of cardiac implantable electronic device (CIED)-related complications are increasing worldwide. Transvenous laser lead extraction is a way to meet the rising complexity of cases, but knowledge about the impact of body-mass-index (BMI) on this procedure is limited.

Methods and Results
All patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database were stratified by BMI in accordance to the World Health Organization (WHO) definition. Patient characteristics, as well as procedural outcomes were analyzed. Within the group of obese patients (BMI ≥30kg/m2), predictors for adverse outcomes (procedural failure, complications, all-cause mortality) were assessed.
A total of 2524 patients were divided into 5 groups (Underweight: BMI &lt;18.5 kg/m2, Regular weight: BMI 18.5-24.5 kg/m2; Overweight: BMI 25.0-29.9 kg/m2, Obese 1: 30.0-34.9 kg/m2, Obese 2: BMI &gt;35.0 kg/m2). Most patients (46.6%) were overweight (BMI 25.0-29.9kg/m2). The prevalence of metabolic comorbidities, such as arterial hypertension (84.2%; p&lt;0.001), chronic kidney disease (36.8%; p=0.020) and diabetes mellitus (51.1%; p&lt;0.001) were highest amongst patients in group Obese 2. In this patient group (Obese 2), systemic infection was the leading extraction indication (39.8%; p&lt;0.001). There were no differences in minor (p=0.839) or major (p=0.426) complications, procedure-related- (p=0.533) and all-cause mortality (p=0.333) between groups. Rates for clinical procedural success (p=0.504) were indifferent between groups. Procedural time (p=0.450) and postoperative period of hospitalization (p=0.09) were not significantly different between groups. Multivariate analyses of groups Obese 1+2 revealed lead age ≥10 years as predictor or procedural failure (OR: 2.99; 95% CI: 1.06-8.45; p=0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31-8.10; p=0.011) and the presence of abandoned leads (OR: 3.08; 95% CI: 1.03-9.22; p=0.044) were identified as predictors of procedural complications, whereas a patient age ≥75 years seemed to be protective against complications (OR: 0.27; 95% CI: 0.08-0.93; p=0.039). Chronic kidney disease (OR: 3.20; 95% CI: 1.32-7.80; p=0.010) and periprocedural complications (OR: 5.33; 95% CI: 1.55-18.32; p=0.008) were identified as predictors of all-cause mortality. After adjustment, systemic infection (OR: 17.68; 95% CI: 4.03-77.49; p&lt;0.001) remained the sole predictor for all-cause mortality.

Conclusion
Laser lead extraction (LLE) in obese patients did not show higher rates of complications. Procedural time as well as duration of hospitalization was not prolonged. With considerate planning and in experienced centers, LLE is a safe and efficacious option for this patient collective. Systemic infection is the main driver of mortality in obese patients with BMI ≥ 30 kg/m2.