Laser Lead Extraction: Predictors of Success and Complications

Objectives: Extraction of cardiac implantable electronic device (CIED) leads using excimer laser is in use since > 20 years, but the predictors of success, all-cause complications and mortality are not yet sufficiently statistically evaluated.

Methods: All consecutive laser extractions performed at our institution between September 2011 and March 2020 with lead age > 12 months were included and retrospectively analyzed.

Result: A total of 792 leads (mean age: 75 months) were extracted during 335 procedures. The indication for extraction was pocket infection in 59%, CIED endocarditis in 25%, lead dysfunction or upgrade in 14% and others in 2%.

94.6% of leads were extracted complete, 4.2% partial (< 4 cm rest) and the extraction failed in 1.3% of the leads (retention of ≥ 4 cm rest).

Multivariable analysis identified lead age > 7.5 years (odds ratio [OR]: 6.5; p = 0.0281), broken leads (OR: 28.0; p = 0.0009) and implantable cardioverter-defibrillator (ICD) leads (OR: 6.5; p = 0.0010) as independent predictors of failed extraction. CIED endocarditis was independently associated with complete extraction (OR: 3.3; p = 0.0218).

Complete procedural success or clinical success was achieved in 330 of 335 procedures (98.6%). The lead extraction failed in five cases (1.5%). Major procedure-associated adverse events (injuries of the great vessels or heart) occurred in four cases (1.2%). Two patients died perioperatively (0.6%). Minor complications occurred in 13 cases (3.9%).

Major adverse events (MAE) causally not related to the procedure occurred in 18 (5.4%) of the patients. The most frequent MAE was postoperative aggravation of the sepsis (10 patients; 3.0%). Independent predictors of major adverse events were CIED-endocarditis (OR: 6.0; p = 0.0175), preoperative C-reactive-protein (CRP) > 35 mg/L (OR: 3.8; p = 0.0412) and body mass index (BMI) ≥ 25 kg/m2 (OR 5.0; p = 0.0489).

Ten patients (3%) died during the hospital stay. CIED-endocarditis with preoperative CRP > 35 mg/L was independently associated with hospital mortality in multivariable analysis (OR: 10.7; p = 0.0020). The Kaplan–Meyer analysis of 30-day mortality showed a significant worse survival of patients with endocarditis (log-rank p = 0.0102).

Conclusion: Leads > 7.5 years, broken leads and ICD leads are independent predictors of failed extraction. CIED endocarditis, CRP > 35 and BMI ≥ 25 are associated with MAE. CIED endocarditis is related to higher short-term mortality despite successful lead extraction.

Publication History

Article published online:
19 February 2021