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

Abstract

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