Long-term survival following transvenous lead extraction. Importance of indication and comorbidities

Background: Long-term outcomes are poorly understood, and data is lacking in patients undergoing transvenous lead extraction (TLE). Objective: The purpose of this study was to evaluate factors influencing survival in patients undergoing TLE depending on extraction indication. Methods: Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively collected. The total cohort was divided into groups depending on whether there was an infective or non-infective indication for TLE. We evaluated the association of demographic, clinical, device-related and procedure-related factors on mortality. Results: 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n=392). 632 (54.9%) and 519 patients (45.1%) were for infective and non-infective indications respectively - a higher proportion died in the infection group (38.6% vs 28.5%, p<0.001). In the total cohort, multivariable analysis demonstrated increased mortality risk with age>75 years (HR=2.98, CI[2.35-3.78], p<0.001), eGFR<60ml/min/1.73m2 (HR=1.67, CI[1.31-2.13], p<0.001), higher cumulative co-morbidity (HR=1.17, CI [1.09-1.26], p<0.001), reduced risk per percentage increase in LVEF (HR=0.98, CI[0.97-0.99], p<0.001), and near unity per year of additional lead dwell time (HR=0.98, CI[0.96-1.00], p=0.037). Kaplan Meier survival curves demonstrated worse prognosis with a higher number of leads extracted and increasing co-morbidities. Conclusion: Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests also assessing longer-term outcomes when considering TLE in those with a high risk of medium and long-term mortality, particularly for non-infective indications.