Indication-Stratified Early Outcomes After Transvenous Lead Extraction in Hemodialysis Patients: Analysis of a Prospective 1,256-Patient Registry

Q: What are the key findings of this study?

Malfunction-related transvenous lead extraction in hemodialysis patients was associated with a 27.3% major complication rate and 18.2% 30-day mortality despite preserved procedural success.

Kunal B. Shah; Salomón Giraldo; Christopher James; Roger G. Carrillo

doi:10.1016/j.hroo.2026.03.016

March 1, 2026Heart Rhythm O2Open Access

Indication-Stratified Early Outcomes After Transvenous Lead Extraction in Hemodialysis Patients: Analysis of a Prospective 1,256-Patient Registry

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Key result

Malfunction-related TLE in hemodialysis patients linked to ~27% major complication rate despite preserved procedural success.

Figures

Why the study?

Hemodialysis status is a known risk factor after transvenous lead extraction, but the influence of extraction indication on early outcomes within this population remains incompletely defined.

Does procedural indication affect early outcomes and 30-day mortality in hemodialysis patients undergoing transvenous lead extraction?

Key Points

To evaluate early and 30-day outcomes following transvenous lead extraction in hemodialysis versus non-hemodialysis patients and assess whether procedural indication alters early risk.
Analyzed a prospectively maintained, single-center registry of 1,256 patients (86 receiving hemodialysis) undergoing transvenous lead extraction between 2004 and 2025.
Stratified patients by hemodialysis status and primary extraction indication (infection-related vs noninfectious/malfunction-related).
Evaluated primary outcomes including procedural success, survival to discharge, and 30-day all-cause mortality, defined per 2017 Heart Rhythm Society consensus criteria.
In infection-related cases (HD n=64; non-HD n=511), hemodialysis patients had longer hospital stays (17.5 ± 13.7 days vs 12.8 ± 10.1 days, p = 0.01) with procedural success, survival to discharge, and 30-day mortality not statistically different.
In malfunction-related cases (HD n=22; non-HD n=659), hemodialysis patients experienced higher major complication rates (27.3%, 95% CI: 10.7%–50.2% vs 2.7%, 95% CI: 1.6%–4.4%) and higher 30-day mortality (18.2%, 95% CI: 5.2%–40.3% vs 0%, 95% CI: 0.0%–0.6%).
Hemodialysis status was independently associated with the composite endpoint of major complication or 30-day mortality (adjusted OR 3.02, 95% CI 1.71–5.35, p<0.001), with a significant interaction between dialysis status and indication (p-interaction = 0.0002).

Structured PICO

Does procedural indication affect early outcomes and 30-day mortality in hemodialysis patients undergoing transvenous lead extraction?

P

Population

1,256 patients undergoing transvenous lead extraction (TLE), including 86 receiving hemodialysis (HD) and 1,170 non-HD patients.

I

Intervention

Transvenous lead extraction (TLE) for infection-related or noninfectious/malfunction-related indications.

C

Comparator

Non-hemodialysis patients undergoing TLE, and comparison between extraction indications within the hemodialysis cohort.

O

Outcome

Survival to discharge and 30-day all-cause mortality.hard clinical

Hemodialysis patients undergoing transvenous lead extraction for malfunction-related indications have a significantly higher risk of early complications and 30-day mortality, highlighting the need for careful peri-procedural planning.

Limitations

Single-center observational study
Small number of HD patients undergoing TLE for noninfectious-related indications
Residual confounding cannot be excluded
Noninfectious indications were captured as 'lead malfunction' without standardized subcategorization

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Implication

Warrants careful peri-procedural planning in hemodialysis patients; hypothesis-generating for risk-reduction strategies in transvenous lead extraction.

Abstract

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Cite This Study

Shah et al. (2026) studied this question. Malfunction-related transvenous lead extraction in hemodialysis patients was associated with a 27.3% major complication rate and 18.2% 30-day mortality despite preserved procedural success.

synapsesocial.com/papers/69c0de74fddb9876e79c1386 https://doi.org/10.1016/j.hroo.2026.03.016

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Indication-Stratified Early Outcomes After Transvenous Lead Extraction in Hemodialysis Patients: Analysis of a Prospective 1,256-Patient Registry

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Indication-Stratified Early Outcomes After Transvenous Lead Extraction in Hemodialysis Patients: Analysis of a Prospective 1,256-Patient Registry

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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