Abstract 4370012: Outcomes of Transvenous Lead Extraction in Young Patients

Abstract

Background: Transvenous lead extraction (TLE) is increasingly necessary for CIED management, especially young patients who are likely to require multiple device revisions over their lifetime. Data comparing TLE outcomes across distinct young patient subgroups remains limited. Hypothesis: TLE can be performed with high efficacy and low complication in young patients, regardless of age group. Methods: This study analyzed 643 patients aged ≤45 years, from a prospectively maintained registry, who underwent TLE between 1996 and 2022 at a high-volume US tertiary center. Patients were stratified into 3 groups: pediatric (≤18 years, n=38), transitional (>18-30 years, n=157), and young adult (>30-45 years, n=448). Procedural parameters and outcomes were compared. Multivariable logistic regression assessed age as a predictor of complications, adjusting for sex, congenital heart disease, hypertension, diabetes mellitus, ICM, NICM, infection indication, ICD, number of extracted leads, dwell time of the oldest lead, and CS lead. Results: Patient characteristics are summarized in Table 1 . Lead malfunction was the most common extraction indication across all groups but more frequently observed in pediatric (61%) and transitional (55%) patients than young adults (44%, p=0.02). Fluoroscopy duration was similar (p=0.4), as was the use of advanced extraction tools, including laser sheaths (p=0.7), mechanical sheaths (p=0.9), and femoral workstations (p=0.1). Nonetheless, the majority of cases required advanced tools in all groups, reflecting a high degree of procedural complexity across the cohort. Complete procedural success exceeded 94% in all age groups (p=0.95), and clinical success exceeded 96% (p=0.9). No intraprocedural deaths occurred. Major complications were infrequent (pediatric 2.6%, transitional 1.3%, young adult 4.2% (p=0.2) and minor complications occurred in 0, 1.9%, and 2.7% of patients, respectively (p=0.6), with no significant differences across subgroups. Multivariable analysis revealed no association between age and major (OR=1.04, 95%CI: 0.98-1.12; p=0.2) or minor (OR=1.05, 95%CI: 0.97-1.14; p=0.3) complications. Conclusion: TLE in young patients is associated with high procedural success and low complication rates across all age strata. Despite different anatomical and technical challenges between different life stages, outcomes are favorable when performed in specialized centers, supporting age-informed but not age-limited extraction strategies.