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.