The GermAn Laser Lead Extraction RegistrY: GALLERY.

AIMS: The GermAn Laser Lead Extraction RegistrY: GALLERY is a retrospective, national multicentre registry, investigating the safety and efficacy of laser lead extraction procedures in Germany. METHODS AND RESULTS: Twenty-four German centres that are performing laser lead extraction have participated in the registry. All patients, treated with a laser lead extraction procedure between January 2013 and March 2017, were consecutively enrolled. Safety and efficacy of laser lead extraction were investigated. A total number of 2524 consecutive patients with 6117 leads were included into the registry. 5499 leads with a median lead dwell time of 96 (62-141) months were treated. The mean number of treated leads per patient was 2.18 ± 1.02. The clinical procedural success rate was 97.86% and the complete lead removal was observed in 94.85%. Additional extraction tools were used in 6.65% of cases. The rate of procedural failure was 2.14% with lead age ≥10 years being its only predictor. The overall complication rate was 4.32%, including 2.06% major and 2.26% minor complications. Procedure-related mortality was 0.55%. Female sex and the presence of abandoned leads were predictors for procedure-related complications. The all-cause in-hospital mortality was 3.56% with systemic infection being the strongest predictor, followed by age ≥75 years and chronic kidney disease. CONCLUSION: In the GALLERY, a high success- and low procedure-related complication rates have been demonstrated. In multivariate analysis, female sex and the presence of abandoned leads were predictors for procedure-related complications, while the presence of systemic infection, age ≥75 years, and chronic kidney disease were independent predictors for all-cause mortality.

New generation of transvenous left ventricular leads - first experience with implantation of multipolar left ventricular leads.

BACKGROUND: Aside from unfavourable anatomy, inacceptable pacing thresholds and phrenic nerve stimulation represent major obstacles for successful left ventricular (LV) lead placement for cardiac resynchronization therapy (CRT). OBJECTIVE: To implant, for the first time, a new generation of transvenous multipolar LV leads (a quad-electrode lead) in combination with a CRT-cardioverter defibrillator, and to demonstrate that this combination allows for 10 different pacing vectors to combat the problems cited above. METHODS: Thirty patients were selected for CRT-cardioverter defibrillator implantation. At implantation, standard lead parameters were recorded. The reason for choosing a vector other than the standard bipolar vector for LV pacing, the LV lead implantation time, x-ray exposure time required for lead placement, and the reason for and number of repositions were documented. Before hospital discharge, a system inspection was performed. RESULTS: The implantation lead parameters were satisfactory. In 17 patients, a vector other than the standard bipolar vector was chosen to avoid phrenic nerve stimulation or to establish a better pacing threshold. In seven cases, the LV lead was repositioned (three phrenic nerve stimulations, two inacceptable pacing captures and two nonstable lead positions). Phrenic nerve stimulation was noted in eight cases; however, in five, this was eliminated by changing the stimulation vector. At hospital discharge, two-thirds of patients retained the implantation stimulation vector and in one-third, the vector was modified to further optimize the system. CONCLUSIONS: The quad-electrode lead provides good handling and may reduce the risk of inacceptable pacing thresholds and phrenic nerve stimulation. Consequently, implantation time, x-ray exposure and contrast agent load may be decreased, leading to lower kidney stress. Furthermore, the option for vector change after implantation may reduce the number of necessary reinterventions resulting from the pacing threshold and impedance increase.