Systematic review and meta-analysis of the safety and efficacy of transvenous lead extraction in octogenarian patients

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INTRODUCTION: As the global population ages and the use of cardiac implantable electronic devices (CIEDs) increases, transvenous lead extraction (TLE) is being performed more frequently in elderly patients. Concerns remain regarding its safety and efficacy in octogenarians, and age‑specific recommendations are limited. OBJECTIVES: We aimed to assess procedural success, complication rates, and mortality associated with TLE in patients aged 80 years or older in comparison with younger individuals. PATIENTS AND METHODS: A systematic search of PubMed, Cochrane CENTRAL, SciELO, and ScienceDirect was conducted up to December 2024. Studies reporting TLE outcomes in octogenarians and younger patients were included according to predefined criteria. A meta‑analysis was performed to compare procedural success, complications, and mortality between the age groups. RESULTS: Seventeen studies including 15 984 patients were analyzed. Complete lead extraction success was 96.7% in octogenarians and 96.2% in the patients aged below 80 years. No significant differences were observed in major or minor procedural complications. In‑hospital mortality was low and comparable between the groups. Although long‑term mortality was higher in the octogenarians, this reflected greater baseline comorbidity and frailty rather than increased procedural risk. None of the included studies demonstrated higher periprocedural danger of TLE in elderly patients. CONCLUSIONS: TLE is safe and effective in patients aged 80 years and older, with outcomes comparable to younger individuals. Advanced age alone should not preclude referral for lead extraction.

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