Long–term Outcomes Following Transvenous Lead Extraction: Data From a Tertiary Referral Center

Abstract Transvenous lead extraction (TLE) has been established as a procedure with a satisfactory safety and efficacy profile in both intraoperative and short–term postoperative setting. However, data on long–term outcomes are limited. The purpose of this study was to evaluate long–term outcomes and prognostic factors in patients who underwent TLE. Patients with a cardiac implantable electronic device (CIED) who underwent TLE between 2014 and 2016 were included in a retrospective analysis. The primary outcome was a composite of all–cause mortality and repeated TLE procedure, stratified based on the indication for CIED infection or reasons other than infection. Secondary outcomes included the individual components of the primary outcome. A total of 191 patients were included in the analysis, with 50% (n=96) undergoing TLE due to CIED–related infection. Complete procedural success was achieved in 189 patients (99%), with no major acute complications. After a median follow–up of 6.5 years, the presence of infection at the time of TLE was associated with significantly lower event–free survival (67% vs. 83% in the non–infection group, adjusted hazard ratio aHR 1.97, 95% confidence interval CI 1.02–3.81, p = 0.04). The all–cause mortality rate was higher in the infected group (30% vs. 10%, p 0.01). Conversely, the rate of repeated TLE did not differ significantly between the two groups (4% vs. 7%, p = 0.62). Among patients undergoing TLE due to infection, the presence of vegetations on leads or valvular apparatus (aHR 2.56; 95%CI 1.17–5.63, p = 0.02) and positive blood cultures (aHR 2.64; 95%CI 1.04–6.70, p = 0.04) were independently correlated with the primary outcome. Subgroup analysis based on gender revealed that female patients had a higher risk of minor intraprocedural and periprocedural complications (17.2% vs. 2.5%, p 0.01), but no differences in long–term outcomes. Patients undergoing TLE for CIED–related infection demonstrate a high risk of long–term mortality. Systemic infection, indicated by vegetations and positive blood cultures, is associated with a worse prognosis, independent of the procedural complexity and success. Female patients exhibit an increased risk of minor intraprocedural and periprocedural complications.