1Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; 3Asklepios Klinik St. Georg Abteilung Herzchirurgie Hamburg, Deutschland
Background:
Transvenous lead extraction (TLE) in patients with cardiac implantable electronic devices has become a well-established therapy for patients with lead complications. However, there is limited information on specific outcomes for patients with right-sided leads compared to patients with left-sided leads undergoing TLE.Aim:
The aim of this study was to analyze patient characteristics, procedural outcomes as well as adverse events and mortality of patients with right-sided leads undergoing TLE with the excimer laser sheath as a first line therapy.
Methods:
We performed a subgroup analysis of all reported patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) with unilateral right-sided leads (Group 1) or unilateral left-sided leads (Group 2).
Results:
2438 patients with unilateral leads were analyzed. 750 patients were in Group 1 and 1688 patients were in Group 2. Patients in Group 1 were older (71.1 ± 13.9 vs. 66.5 ± 13.6; p < 0.001), more patients were female (31.7% vs. 22.1%, p < 0.001), and had a lower body-mass-index (26.8 ± 4.5 vs. 27.2 ± 4.7; p=0.03). Patients in Group 2 more often had a left ventricular ejection fraction below 30 % (33.1% vs. 10.3%, p< 0.001), coronary artery disease (45.9% vs. 35.9% p< 0.0001), chronic kidney disease 32.0% vs. 27.3%, p=0.024) or previous heart surgery (25.5% vs. 20.9%, p=0.016). However, more patients in Group 1 were pacemaker dependent (44.9% vs. 25.4%, p< 0.001). The primary indication for TLE was local infection (46.0% vs. 30.6%, p< 0.001) in Group 1 and lead dysfunction (20.0% vs. 36.1%, p< 0.0001) in Group 2. The frequency of TLE for systemic infection was indifferent between groups (28.9% vs. 27.6%, p=0.532). The most common device to be extracted were pacemakers (80.1% vs. 22.7%, p< 0.001) in Group 1 and implantable cardioverter-defibrillators (ICD) (9.7 vs. 45.3%, p< 0.001) and cardiac resynchronization therapy devices (CRT) (9.6 vs. 31.5%); p< 0.001) in Group 2. The mean number of total leads was not different between groups (2.4 ±0.9 for Group 1 vs. 2.3 ± 1.0 for Group 2; p=0.98), however median lead dwell time (120 vs. 85 months, p< 0.001), patients with abandoned leads (32.0% vs. 25.9%; p=0.0022) and the use of additional extraction tools (8.4% vs. 5.7%, p=0.016) were significantly higher in Group 1. Patients with right-sided leads had a longer median hospital stay (10 vs. 9 [5; 15] p=0.001). Complete procedural success was higher in patients Group 2 (89.1 vs. 93.1%, p=0.001) but there was no difference in clinical success rates (97.7% vs. 98.0%, p=0.74). There was no difference in overall complication rates (4.3% vs. 4.2%, p=0.945). Neither procedure related mortality (0.3% vs. 0.7%, p=0.2940) nor all-cause mortality (3.5% vs. 3.4%, p=0.9101) differed between groups.
Conclusion:
TLE procedures in patients with right-sided leads showed a lower procedural success rate and a higher need of additional tools. This patient group was older, more often pacemaker dependent and had a higher number of abandoned leads. Despite different patient and lead characteristics, there were no differences in clinical success-rates, procedure related complications or all-cause mortality between groups.