Laser lead extraction of very old leads – Insights from the GermAn Laser Lead Extraction RegistrY (GALLERY)

Da-Un Chung (Hamburg)1, H. Burger (Bad Nauheim)2, N. Ghaffari (Karlsruhe)3, V. Ziaukas (Bad Rothenfelde)4, T. Madej (Dresden)5, H. Reichenspurner (Hamburg)6, C. Butter (Bernau bei Berlin)7, N. Geßler (Hamburg)1, S. Willems (Hamburg)1, S. Pecha (Hamburg)6, S. Hakmi (Hamburg)8

1Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 2Kerckhoff Klinik GmbH Herzchirurgie Bad Nauheim, Deutschland; 3HELIOS Klinik für Herzchirugie Karlsruhe Karlsruhe, Deutschland; 4Schüchtermann-Klinik Bad Rothenfelde Herzchirurgie Bad Rothenfelde, Deutschland; 5Herzzentrum Dresden GmbH an der TU Dresden Klinik für Herzchirurgie Dresden, Deutschland; 6Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Herz- und Gefäßchirurgie Hamburg, Deutschland; 7Immanuel Klinikum Bernau Herzzentrum Brandenburg / Kardiologie Bernau bei Berlin, Deutschland; 8Asklepios Klinik St. Georg Abteilung Herzchirurgie Hamburg, Deutschland



Transvenous lead extraction (TLE) has become one of the most crucial therapeutic pillars in modern cardiac implantable electronic device management, especially for patients with cardiac-device related infections and lead dysfunction. Very old pacemaker and defibrillator leads are known to be risk factors for procedural complications and -failure 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 <10 years, in terms of baseline- and lead characteristics, as well as procedural outcomes and potential predictors of adverse events.


We identified 858 patients with at least one lead aged ≥10 years (Group A) and 1666 patients with leads aged <10 years (Group B). Patients in Group A were older (70.4±13.7 vs. 66.7±13.7; p<0.001) and are less likely to exhibit a highly reduced LVEF (18.5 vs. 30.0%, p<0.001) or coronary artery disease (36.1 vs. 46.4%, p<0.001), compared to Group B. Group A had a higher proportion of patients with pacemaker dependency (38.0 vs. 27.6%, p<0.001). Thus, pacemakers were the most prevalent device in Group A (56.6 vs. 31.2%, p<0.001), whereas ICDs (25.4 vs. 39.4%, p<0.001) and CRT devices (18.2 vs. 28.5%, p<0.001) were more common in Group B. The mean numbers of leads per patient were 2.5±1.1 and 2.4±1.0 (p<0.001) with median ages of the oldest indwelling lead of 161.5 [IQR: 137-206.75] and 72.0 [48-94] months (p<0.001). Patients in Group A had higher proportions of right-sided (47.7 vs. 25.8%, p<0.001) and abandoned leads (41.3 vs. 23.4%, p<0.001). Most patients in Group A had 2 leads with a dwell time ≥10 years (n=533; 62.1%). Median procedural time was longer in Group A with 93.5 [63-145] vs. 75 [52-116] minutes (p<0.001) with an increased necessity for additional tools for extraction (12.6 vs. 3.4%, p<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<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 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<0.001) and a BMI ≥35 kg/m(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<0.001) and systemic infection (OR:18.7, 95%CI: 5.6-62.9, p>0.001) were highly predictive for all-cause mortality. 



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 procedure-related- or all-cause mortality, when compared to patients with leads aged <10 years. The necessity of additional tools for extraction and a BMI ≥35 kg/m2 were identified as predictors for procedural failure. 

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