Transvenous extraction of quadripolar coronary sinus pacing leads

Quadripolar coronary sinus (CS) leads are commonly employed to achieve left ventricular pacing. There are limited data on extraction of these leads relative to traditional unipolar or bipolar CS pacing leads.

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 CS leads.

Patients who underwent extraction of CS leads between 2013 and 2024 were included. Outcomes of interest were rates of complete CS lead removal, complete procedural success, major adverse events, and successful reimplantation in the CS.

A total of 182 patients were included (102 quadripolar leads and 80 non-quadripolar leads). The mean age of the patients was 68.0 ± 11.6 years, and 22% were female. The mean CS lead age was significantly lower in the quadripolar group (3.0 ± 2.7 years vs 8.2 ± 4.3 years; P < .001). The complete procedural success rate was significantly higher in the quadripolar group (99% vs 90%; P = .01); there was no difference between groups after accounting for lead age. There was no significant difference in complete CS lead removal rates between groups (99% vs 95%; P = .17). Two major adverse events occurred in the non-quadripolar group and were directly related to lead extraction. 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 = .30).

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 often limited by CS branch stenosis or occlusion.