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

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BACKGROUND: Transvenous lead extraction (TLE) is increasingly performed in older adults, but literature has reported divergent outcomes in very old populations. OBJECTIVE: This study aimed to investigate the impact of patient age on TLE outcomes, with an emphasis on older patients. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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