Abstract 4146091: Transvenous Extraction of Quadripolar Coronary Sinus Pacing Leads Is Feasible and Safe

Introduction/Background: Quadripolar coronary sinus (CS) leads are commonly employed in cardiac resynchronization therapy. There are limited data on extraction of these leads. The presence of additional electrode terminals on quadripolar leads (compared to unipolar or bipolar leads) has raised concerns about CS fibrosis and extraction difficulty. Goals/Aims: The purpose of this study was to examine the safety and efficacy of quadripolar CS lead extraction and CS lead reimplantation, and to compare outcomes with extraction of non-quadripolar (unipolar or bipolar) CS leads. Methods/Approach: In this retrospective cohort study, patients who underwent extraction of CS leads between 2013 and 2024 at a large tertiary care center were included. Outcomes of interest included rates of complete CS lead removal, complete procedural success, major adverse events, and successful reimplantation in the CS. Group means were compared using the two-sample t-test assuming independent samples and unequal variances. Nominal categorical variables were analyzed with the Chi-square test or Fisher exact test where appropriate. A p value less than 0.05 was considered significant. Results/Data: A total of 182 patients were included (n = 102 quadripolar leads and n = 80 non-quadripolar leads). The mean patient age was 68.0 ± 11.6 years and 22% were female. The mean CS lead age was lower in the quadripolar group (3.0 ± 2.7 years vs. 8.2 ± 4.3 years, p < 0.001), and the complete procedural success rate was higher (99% vs. 90%, p = 0.01). There was no significant difference in complete CS lead removal rates between groups (99% vs. 95%, p = 0.17). There were no major adverse events in the quadripolar group, and two major adverse events occurred in the non-quadripolar group. In the quadripolar group, manual traction alone was successful in 59%, laser sheaths were used in 39%, and rotational cutting tools were used in 9%. In the non-quadripolar group, manual traction alone was successful in 19%, laser sheaths were used in 79%, and rotational cutting tools were used in 26%. There was no significant difference in reimplantation success rates between groups (82% vs. 90%, p = 0.30). Conclusions: Quadripolar CS lead extraction had a high success rate and low rate of major adverse events. Reimplantation in the CS was possible with a good success rate but was limited by CS branch stenosis or occlusion.