Short-term outcomes of transvenous lead extraction in adults with congenital heart disease

Background Cardiac implantable electronic devices are essential for arrhythmia management in adults with congenital heart disease (ACHD) but confer risks of complications requiring transvenous lead extraction (TLE). Large-scale safety data on TLE in ACHD remains limited. Objective To evaluate short-term outcomes of TLE in ACHD. Methods We queried the TriNetX database for adults (≥18 years) who underwent TLE. ACHD was identified using ICD-9/10 codes and categorized by anatomic complexity. The primary outcome was 30-day all-cause mortality. Secondary outcomes included cardiac arrest, need for surgery, tamponade, stroke, hemorrhage, and acute kidney injury (AKI). Outcomes were compared after 1:1 propensity matching for (1) ACHD vs. non-ACHD, (2) complex vs. simple ACHD, and (3) ACHD with vs. without endocarditis. Results Among 63,506 patients (4,433 ACHD; 59,073 non-ACHD), ACHD patients were younger (51.8 ± 21.5 vs. 66.5 ± 15.5 years) and had more endocarditis (19.1% vs. 9.1%). After matching (n = 4,004 pairs), ACHD and non-ACHD had similar 30-day mortality (1.5% vs. 2.0%; OR 0.78 [0.56–1.09], p=0.15). They had similar rates of cardiac arrest, tamponade, stroke, hemorrhage, and AKI. Need for surgery was higher in ACHD (2.0% vs. 1.3%; OR 1.49 [1.05–2.11], p=0.02). Complex and simple ACHD had similar mortality (1.3% vs. 1.2%; OR 1.08 [0.50–2.30], p=0.85). ACHD with endocarditis was associated with greater mortality (2.9% vs. 1.5%; OR 2.03 [1.04–3.98], p=0.04). Conclusions TLE in ACHD demonstrates 30-day mortality comparable to non-ACHD adults, supporting procedural safety at experienced centers. Surgical preparedness remains essential.