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 To evaluate the procedural outcomes of TLE in young adults using the UC San Diego Lead Extraction Registry. Methods Patients who underwent TLE between January 2012 and December 2024 were included and stratified by age into two groups: ≤ 50 years (Group 1) or > 50 years (Group 2). We compared procedural characteristics and outcomes between the two groups. Results Of 1,025 patients in this study, 173 patients (17%) were ≤ 50 years (Group 1) and 852 patients (83%) were > 50 years (Group 2). Group 1 was younger at time of initial device implantation (28.2 ± 11.0 vs 62.0 ± 11.2 years, p < 0.001). 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 need for upsizing laser sheath or switching to a rotating mechanical sheath (OR 0.977, 95% CI 0.966-0.988, p < 0.001), lower chance of complete procedural success (OR 1.024, 95% CI 1.003-1.046, p=0.025), and increased fluoroscopy time (beta coefficient -0.183, 95% CI -0.207 – -0.061, p < 0.001). There were no differences in major (3.5% vs 1.8% p=0.079) and minor (1.7% vs 2.3%, p=0.619) complications. 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 pre-procedural planning.