Transvenous Lead Extraction Outcomes in Hemodialysis Patients: Markers for Increased Mortality

BACKGROUND: The increasing use of cardiac implantable electronic devices (CIEDs) has led to a progressive increase in transvenous lead extraction (TLE) procedures. Due to immune compromise and systemic dysfunction, hemodialysis (HD) patients face higher risks of device-related infection and need for TLE. OBJECTIVES: This study evaluates TLE outcomes in dialysis patients and identifies predictors of 30-day all-cause mortality (ACM). Subgroup analysis focuses on dialysis patients undergoing TLE for infectious indications to determine predictors of adverse outcomes. METHODS: A retrospective review of TLE procedures performed from 2013 to 2022 (n = 1614) identified 53 patients (3.3%) on HD. Procedural outcomes and 30-day ACM were compared between HD and non-HD cohorts using chi-square tests. Predictors of 30-day ACM were assessed with Cox regression. For HD patients with infectious indications (n = 48), preprocedural findings, including pocket infection, positive blood cultures, and intracardiac mass, were evaluated for their impact on outcomes. RESULTS: Procedural success and complication rates were similar between HD and non-HD groups, but 30-day ACM was significantly higher in HD patients (13.2% vs. 2%; p < 0.001). Independent predictors of 30-day ACM included HD, infectious indication for TLE, and NYHA Class 3/4 symptoms. Among HD patients with infectious indications, visualization of intracardiac mass on echocardiography predicted higher 30-day ACM (33.3% vs. 6.1%; p = 0.01) and was confirmed as an independent predictor (OR 24.88; 95% CI 1.7-374.3; p = 0.02). CONCLUSION: Dialysis is an independent predictor of 30-day ACM after TLE. In dialysis patients with infectious indications, intracardiac mass is a prognostic factor for adverse outcomes.