BACKGROUND: Older pacemaker- and defibrillator leads are established risk factors for complications during transvenous lead extraction (TLE), yet its impact on procedural outcomes remains clinically relevant.

OBJECTIVE: To compare TLE outcomes between patients with cardiac leads ≥10 years old (Group A, n=858) and those with leads <10 years old (Group B, n=1666).

METHODS: This retrospective comparative analysis focused on baseline and lead characteristics, procedural outcomes, and identifying predictors of adverse events.

RESULTS: Group A patients were older (70.4±13.7 vs. 66.7±13.7; p<0.001), had more indwelling leads (2.5±1.1 vs. 2.4±1.0; p<0.001) and had longer lead dwell times (13.45 [11.41; 17.22] and 6.0 [IQR:4.0-7.8] years (p<0.001)), than Group B patients. Procedural duration was longer (93.5 [IQR:63-145] vs. 75 [IQR:52-116] minutes (p<0.001)), and the need for additional extraction tools was higher in Group A (12.6vs.3.4%, p<0.001). Overall- (5.5vs.3.6%, p=0.03) and major complication rates (3.2vs.1.4%, p=0.005), as well as procedural failure rates (3.5vs.1.5%, p=0.002), were significantly elevated in Group A. No significant differences were observed in procedure-related- (0.7vs.0.5%, p=0.592) or all-cause mortality (3.5vs.3.2%, p=0.711) between the groups. The use of additional extraction tools (OR:4.4, 95%CI:2.0-9.7, p<0.001) and a BMI ≥35 kg/m2 (OR:4.4, 95%CI:1.4-14.0, p=0.012) were identified as independent predictors of procedural failure.

CONCLUSION: Patients undergoing TLE with older leads face increased procedural complexity and complication risks, requiring more frequent use of advanced extraction techniques and experiencing lower procedural success rates. However, lead age did not impact procedure-related or overall mortality.