Age-stratified outcomes of transvenous lead extraction: A 5090-patient experience from the ExTRACT registry

Transvenous lead extraction (TLE) is increasingly performed in older adults, but literature has reported divergent outcomes in very old populations.

This study aimed to investigate the impact of patient age on TLE outcomes, with an emphasis on older patients.

Using the ExTRACT registry, the largest TLE registry to date, we analyzed 5090 patients who underwent TLE between August 1996 and 2022 at the Cleveland Clinic, a high-volume center. Patients were stratified into 4 age groups: younger adults (<65 years; n = 2345), youngest old (65-74 years; n = 1430), middle old (75-84 years; n = 1056), and oldest old (≥85 years; n = 259). Baseline characteristics and procedural outcomes were compared. Multivariable logistic regression was conducted to assess age as a predictor of procedural complications.

Complete procedural success exceeded 95% in all groups, highest in those aged ≥85 years (97.6% vs 95.5% in <65 years; P = .035). Major complication rates were low and similar across groups (3.5% in ≥85 vs 2.8% in <65 years; P = .517). In-laboratory mortality was rare (0.77% in ≥85 vs 0.13% in <65 years; P = .175). Multivariable analysis found no significant association between age and complications, including sternotomy, superior vena cava/right atrial tear, or death. Increased hemothorax was observed in the ≥85 group (odds ratio, 11.88; 95% confidence interval, 1.50-68.45; P = .008), although incidence remained <1%. Infection was the leading extraction indication in older adults (75% in ≥85 vs 31% in <65 years; P < .001), yet outcomes remained uniformly favorable.

In a high-volume center, TLE is safe and highly effective across all age groups, yielding similar outcomes, save for an increased risk of hemothorax in patients ≥85 years. These findings support age-neutral referral when clinically indicated.