Clinical outcomes of transvenous lead extraction in octogenarians: a real-world propensity score-matched analysis

Background Real-world evidence on procedural safety and clinical outcomes of transvenous lead extraction (TLE) in elderly patients remains limited. This study aimed to evaluate procedural outcomes and complications of TLE in octogenarians. Methods Patients who underwent TLE between June 2016 and August 2025 were retrospectively analyzed. Clinical outcomes were compared between octogenarians and non-octogenarians before and after propensity score matching. Results Overall, 552 transvenous leads (median lead age, 8.1 years) were extracted from 380 patients (median age 67.0 years, 57.1% male). Octogenarians (n = 57, 15%) had smaller body size and a higher prevalence of comorbidities. In the propensity score-matched populations, the primary composite outcome of clinical failure and major complications did not differ significantly between non-octogenarians and octogenarians (5.3% vs. 7.0%, P = 0.908). Secondary outcomes were also comparable, including complete success (94.7% vs. 89.5%, P = 0.341) and clinical success (96.5% vs. 93.0%, P = 0.522). In multivariable analysis, octogenarian status was not associated with the primary outcome, whereas lead age (per 1 year increase) was independently associated with increased risk of the primary outcome (adjusted odds ratio, 1.12; 95% confidence interval, 1.06–1.19; P < 0.001). In subgroup analysis, female octogenarians showed a tendency toward lower procedural success and higher complication rates (complete success 97.8% vs. 82.8%, P = 0.004; clinical success 97.8% vs. 86.2%, P = 0.023; primary outcome 4.5% vs. 13.8%, P = 0.142). Conclusions In this real-world propensity-matched analysis, TLE in octogenarians demonstrated procedural success and safety approximating those of younger patients. A potential sex-specific vulnerability was observed in female octogenarians, which should be considered as hypothesis-generating and requires validation in further study. Capsule summary This study demonstrates that transvenous lead extraction can be performed safely and effectively in selected octogenarians after adjustment for procedural and lead-related confounders, with procedural success and safety approximating those of younger patients. Additionally, the observed signal of lower procedural success and higher complication rates among female octogenarians suggests a potentially vulnerable subgroup, warranting individualized risk assessment and further investigation.