Indication-stratified early outcomes after transvenous lead extraction in hemodialysis patients: Analysis of a prospective 1256-patient registry.

BACKGROUND

Hemodialysis (HD) status is a recognized risk factor for adverse outcomes following transvenous lead extraction (TLE). However, HD patients are frequently analyzed as a single high-risk group, and the influence of extraction indication on early outcomes within this population remains incompletely defined.

OBJECTIVE

This study aimed to evaluate early and 30-day outcomes after TLE in HD and non-HD patients and to assess whether procedural indication (infection vs non-infectious/malfunction-related) is associated with differential early risk among HD patients.

METHODS

We analyzed a prospectively maintained, single-center TLE registry spanning 2004-2025. Patients were stratified by HD status and primary extraction indication. End points were defined according to the 2017 Heart Rhythm Society expert consensus statement. Primary outcomes included survival to discharge and 30-day all-cause mortality.

RESULTS

Among 1256 patients, 86 were receiving HD. Infection-related TLE accounted for 575 cases (HD n = 64; non-HD n = 511), whereas non-infectious/malfunction-related TLE accounted for 681 cases (HD n = 22; non-HD n = 659). In infection-related extractions, HD patients experienced longer length of stay but similar procedural success, survival to discharge, and 30-day mortality. In contrast, HD patients undergoing malfunction-related TLE had higher major complication rates (27.3%, 95% confidence interval [CI]: 10.7%-50.2%) and higher 30-day mortality (18.2%, 95% CI: 5.2%-40.3%), despite preserved procedural success. Interpretation is limited by the small number of HD patients in this subgroup.

CONCLUSION

In this prospective registry, procedural indication was associated with differential early outcomes among HD patients undergoing TLE. Malfunction-related extraction was associated with higher observed early event rates in HD patients and may warrant additional peri-procedural consideration.