Indications for transvenous lead extraction and its procedural and early outcomes in elderly patients: a single-center experience

Introduction: Due to the prolonged survival of patients with cardiovascular implantable electronic devices, leads often need to be removed in elderly individuals.

Objectives: We aimed to analyze indications for transvenous lead extraction (TLE), procedure effectiveness and safety, as well as 30-day follow-up in younger patients (≤80 years) and octogenarians (>80 years).

Patients and methods: This prospective study included 667 patients who underwent TLE: 90 octogenarians (13.5%) at a mean age of 83.8 (range, 80.4–93) years and 577 younger patients (86.5%) at a mean age of 64.2 (range, 18.9–79.9) years.

Results: Octogenarians had a greater number of comorbidities, fewer implantable cardioverter-defibrillators implanted, and more frequently had infection as an indication for TLE, as compared with younger patients (33.3% vs 17.1%; P <0.001). In octogenarians, 138 leads were extracted, as compared with 894 leads in younger patients. Octogenarians and younger patients had similar rates of complete lead removal (98.6% and 97.1%, respectively; P = 0.48), total procedural success (97.8% and 96%, respectively; P = 0.7), major complications (0% and 1.6%, respectively; P = 0.45), and minor complications (2.2% and 1.6%, respectively; P = 0.45). There was 1 death associated with TLE in younger patients. Non–procedure-related deaths within 30 days after TLE were more frequent in octogenarians than in younger patients (5.6% vs 1.9%; P = 0.04).

Conclusions: We showed that TLE in patients older than 80 years seems to be as effective as in younger patients; however, it is associated with significantly higher non–procedure-related 30-day mortality.