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

BACKGROUND

Older pacemaker and defibrillator leads are established risk factors for complications during transvenous lead extraction (TLE); however, its impact on procedural outcomes remains clinically relevant.

OBJECTIVE

This study aimed to compare TLE outcomes between patients with cardiac leads ≥10 years old (Group A, n = 858) and those with leads <10 years old (Group B, n = 1666).

METHODS

This retrospective comparative analysis focused on baseline and lead characteristics, procedural outcomes, and identifying predictors of adverse events.

RESULTS

Group A patients were older (70.4 ± 13.7 vs 66.7 ± 13.7; P < .001), had more indwelling leads (2.5 ± 1.1 vs 2.4 ± 1.0; P < .001) and had longer lead dwell times (13.45 [11.41-17.22] and 6.0 [interquartile range (IQR): 4.0-7.8] years [P < .001]), than Group B patients. Procedural duration was longer (93.5 [IQR: 63-145] vs 75 [IQR: 52-116] minutes [P < .001]), and the need for additional extraction tools was higher in Group A (12.6% vs 3.4%, P < .001). Overall complication rates (5.5% vs 3.6%, P = .03) and major complication rates (3.2% vs 1.4%, P = .005), and procedural failure rates (3.5% vs 1.5%, P = .002) were significantly elevated in Group A. No significant differences were observed in procedure-related mortality (0.7% vs 0.5%, P = .592) or all-cause mortality (3.5% vs 3.2%, P = .711) between the groups. The use of additional extraction tools (odds ratio: 4.4, 95% confidence interval: 2.0-9.7, P < .001) and a body mass index ≥35 kg/m2 (odds ratio: 4.4, 95% confidence interval: 1.4-14.0, P = .012) were identified as independent predictors of procedural failure.

CONCLUSION

Patients undergoing TLE with older leads face increased procedural complexity and complication risks, requiring more frequent use of advanced extraction techniques and experiencing lower procedural success rates. However, lead age did not impact procedure-related or overall mortality.