Key result
Infectious indications for lead extraction are linked to ~5.6-fold higher all-cause mortality vs non-infectious indications.
Why the study?
In transvenous lead extraction (TLE), infectious indications involve greater systemic illness while non-infectious leads are typically older and more fibrotic. Whether these competing factors differentially influence TLE outcomes remained unclear.
Does transvenous lead extraction for infectious indications increase all-cause mortality compared to non-infectious indications in patients with cardiac implantable electronic devices?
Meta-Analysis (n=53,086)
Does transvenous lead extraction for infectious indications increase all-cause mortality compared to non-infectious indications in patients with cardiac implantable electronic devices?
Patients undergoing transvenous lead extraction for infectious indications face significantly higher mortality—especially short-term—than those with non-infectious indications, despite comparable procedural success and fewer pericardial complications.
Answers are grounded in this paper and cite their sources.
Infectious indications warrant intensified short-term monitoring after extraction; leaves open whether targeted interventions can mitigate excess mortality in observational data.
Background: Transvenous lead extraction (TLE) is performed for both infectious and non‐infectious cardiac implantable electronic device (CIED) indications. Infectious indications are associated with greater systemic illness, whereas non‐infectious leads are generally older and more fibrotic. Whether these competing factors differentially influence TLE outcomes remains unclear. Methods: We searched PubMed, Embase, Scopus, and CENTRAL through October 10, 2026 for studies directly comparing TLE outcomes between infectious and non‐infectious indications. Trial registries, conference abstracts, and preprint servers were screened. The primary outcome was all‐cause mortality. Secondary outcomes included procedural success and complications. Random‐effects models were used. Results: Fifteen observational studies comprising 53,086 patients were included. Infectious indications were associated with higher all‐cause mortality (OR 5.61, 95% CI 3.78–8.33; I 2 = 82.3%). The association was greater for short‐term than long‐term mortality (OR 8.57 vs. 2.67; p for interaction < 0.001). Intermediate‐term mortality was also higher (OR 3.84, 95% CI 2.50–5.91). Pericardial complications were less frequent with infectious indications (OR 0.71, 95% CI 0.53–0.95). Clinical and complete procedural success and other complications did not differ significantly. Conclusion: Infectious indications were associated with higher mortality, particularly in the short term, whereas procedural success was comparable. Variation in follow‐up and infection phenotype likely contributed to heterogeneity.
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Sripusanapan et al. (2026) conducted a meta-analysis in Patients undergoing transvenous lead extraction (TLE) for cardiac implantable electronic device (CIED) indications (n=53,086). Infectious indications for transvenous lead extraction vs. Non-infectious indications for transvenous lead extraction was evaluated on All-cause mortality (OR 5.61, 95% CI 3.78-8.33). Infectious indications for transvenous lead extraction were associated with higher all-cause mortality than non-infectious indications.
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