To extract or abandon? That is the question - a systematic review & meta-analysis of transvenous lead extraction vs. abandonment of non-infected, superfluous leads

Background Management of non-infected, redundant pacemaker/ICD leads is controversial. Prophylactic transvenous lead extraction (TLE) may prevent future complications (e.g., infection, venous occlusion) and circumvent the greater technical difficulty of delayed extraction but carries immediate procedural risks. Conversely, lead abandonment (LA) avoids upfront risk, though retained leads might pose long-term issues. In the absence of randomised trials, expert consensus guidelines deem both strategies acceptable options. Methods PubMed, MEDLINE Ovid and EMBASE were searched. Studies were included if they investigated and compared outcomes between TLE to LA and included patients over of 18 years old. Primary endpoints were major complications and in-hospital mortality; secondary outcomes included procedural success and long-term complications or mortality. Pooled odds ratios (OR) with 95% confidence intervals were calculated using a random-effects model. Results We systematically reviewed and meta-analysed sixteen observational studies comparing TLE versus LA of non-infected, redundant leads among 52,655 patients. TLE was associated with double the odds of major complications compared to LA (pooled OR ~2.07 p<0.05), as well as a significantly higher in-hospital mortality. By contrast, a composite outcome of long-term complications and all-cause mortality did not differ significantly between the two strategies during follow-up. Conclusions Although lead extraction carrier a higher initial complication risk, long term outcomes are comparable to those of LA, reinforcing its role as a proactive strategy in select patients. Management decisions should thus be individualised, weighing immediate vs potential future risks. The lack of randomised data highlights the need for prospective trials to inform optimal management.