| Summary: | Background: The incidence of cardiac implantable electronic device (CIED)-related complications, as well as the prevalence of obesity, is rising worldwide. Transvenous laser lead extraction (LLE) has grown into a crucial therapeutic option for patients with CIED-related complications but the impact of obesity on LLE is not well understood. Methods and Results: All patients (<i>n</i> = 2524) from the GermAn Laser Lead Extraction RegistrY (GALLERY) were stratified into five groups according to their body mass index (BMI, <18.5; 18.5–24.9; 25–29.9; 30–34.9; ≥35 kg/m<sup>2</sup>). Patients with a BMI ≥ 35.0 kg/m<sup>2</sup> had the highest prevalence of arterial hypertension (84.2%, <i>p</i> < 0.001), chronic kidney disease (36.8%, <i>p</i> = 0.020) and diabetes mellitus (51.1%, <i>p</i> < 0.001). The rates for procedural minor (<i>p</i> = 0.684) and major complications (<i>p</i> = 0.498), as well as procedural success (<i>p</i> = 0.437), procedure-related (<i>p</i> = 0.533) and all-cause mortality (<i>p</i> = 0.333) were not different between groups. In obese patients (BMI ≥ 30 kg/m<sup>2</sup>), lead age ≥10 years was identified as a predictor of procedural failure (OR: 2.99; 95% CI: 1.06–8.45; <i>p</i> = 0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31–8.10; <i>p</i> = 0.011) and abandoned leads (OR: 3.08; 95% CI: 1.03–9.22; <i>p</i> = 0.044) were predictors of procedural complications, while patient age ≥75 years seemed protective (OR: 0.27; 95% CI: 0.08–0.93; <i>p</i> = 0.039). Systemic infection was the only predictor for all-cause mortality (OR: 17.68; 95% CI: 4.03–77.49; <i>p</i> < 0.001). Conclusions: LLE in obese patients is as safe and effective as in other weight classes, if performed in experienced high-volume centers. Systemic infection remains the main cause of in-hospital mortality in obese patients.
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