Evaluation of transvenous lead extraction in young adults: Insights from the University of California San Diego Lead Extraction Registry.

BACKGROUND

Transvenous lead extraction (TLE) is an important aspect of lead management. The impact of younger age on procedural complexity is not well characterized.

OBJECTIVE

This study aimed to evaluate the procedural outcomes of TLE in young adults using the University of California San Diego Lead Extraction Registry.

METHODS

Patients who underwent TLE between January 2012 and December 2024 were included and stratified by age into 2 groups: ≤50 years (group 1) or >50 years (group 2). We compared procedural characteristics and outcomes between the 2 groups.

RESULTS

Of 1025 patients in this study, 173 patients (17%) were ≤50 years old (group 1) and 852 patients (83%) were >50 years old (group 2). Group 1 was younger at the time of initial device implantation (28.2 ± 11.0 vs 62.0 ± 11.2 years; P < .001). Lead malfunction was the most common indication for extraction in both groups, followed by infection and system upgrade. With multivariable adjustment, younger age was associated with the need for upsizing the laser sheath or switching to a rotating mechanical sheath (odds ratio 0.977; 95% confidence interval [CI] 0.966-0.988; P < .001), lower chance of complete procedural success (odds ratio 1.024; 95% CI 1.003-1.046; P = .025), and increased fluoroscopy time (beta coefficient -0.183; 95% CI -0.207 to -0.061; P < .001). There were no differences in major (3.5% vs 1.8%; P = .079) and minor complications (1.7% vs 2.3%; P = .619).

CONCLUSION

TLE in young adults is associated with increased procedural complexity but without higher rates of complications. The findings highlight the importance of risk stratification and preprocedural planning.