Laser Lead Extraction—Overall Center Experience and Predictors for Adverse Outcome

Background: Laser lead extraction (LLE) of transvenous pacemaker and defibrillator leads may become necessary for various indications. Adverse outcome such as incomplete extraction or mortality can result from this procedure. Our aim was to find predictors for incomplete LLE and in-hospital mortality in our overall cohort.

Methods: Between 01/2012 and 12/2020, 320 consecutive patients underwent LLE at our center. We used multivariable regression analyses to find independent risk factors for incomplete LLE and in-hospital mortality.

Results: Mean age was 65.7 ± 14.8 years, with 72.5% being male. Indications for LLE included local infections in 30.9% of cases, systemic infections in 29.1%, lead dysfunctions in 29.1%, and other combined indications in 10.9%. The average number of implanted leads was 2.4 ± 1.0, with the oldest lead having been in place for an average of 8.7 ± 5.6 years. In 89.7% of cases, all leads scheduled for extraction were successfully removed. The mean durations of laser use and fluoroscopy were 59.0 ± 71.7 seconds and 747.0 ± 728.8 seconds, respectively, while the procedural time averaged 105.1 ± 61.7 minutes. In-hospital mortality was 5.6% (18/320) with 0.6% (2/18) procedure-related deaths. In patients with systemic infections the rate was significantly higher (14.0%, 13/93, p < 0.001). Multivariable regression analysis identified the presence of a lead in the coronary sinus (OR 4.89, CI 2.18–10.96, p < 0.001) and the presence of at least one lead older than 10 years (OR 3.89, CI 1.75–8.67, p < 0.001) as independent predictors of incomplete LLE. Given that postoperative in-hospital mortality was elevated exclusively in patients with systemic infections, a separate multivariable analysis was conducted for this subgroup. In this analysis, prior cardiac surgery emerged as an independent risk factor for in-hospital mortality (OR 6.34, CI 1.71–23.50, p = 0.006).

Conclusion: LLE is an effective procedure, with a high success rate for complete lead removal. However, the procedure carries significant risks, particularly for patients with systemic infections, who exhibited a higher in-hospital mortality rate. Independent predictors of incomplete lead extraction include the presence of leads in the coronary sinus and leads older than 10 years. For patients with systemic infections, prior cardiac surgery is an additional risk factor for in-hospital mortality. These findings underscore the importance of careful patient selection and risk assessment in LLE procedures.

Publication History

Article published online:
11 February 2025