Procedural outcome of transvenous lead extraction in patients with right-sided leads – A GALLERY subgroup analysis

Andrea Schlichting (Hamburg)1, D.-U. Chung (Hamburg)1, E. Rexha (Hamburg)1, L. Kaiser (Hamburg)1, S. Pecha (Hamburg)2, K. Hassan (Hamburg)3, N. Geßler (Hamburg)1, H. Reichenspurner (Hamburg)2, S. Willems (Hamburg)1, S. Hakmi (Hamburg)3

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



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.

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. 

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). 

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.  

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.
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