Background: The lead breakage (LB) during transvenous lead extraction (TLE) increases procedural complexity, increases the risk of complications, and decreases procedural efficiency. This study aimed to identify protective and risk factors for the breakage of cardiac electronic device leads during extraction. Methods: Data were sourced from the EXTRACT prospective registry for TLE procedures conducted between January 2016 and June 2025. A total of 702 consecutive TLE procedures involving 1375 leads were enrolled. Multivariate logistic regression was used to identify independent protective and risk factors and develop a model to predict the occurrence of LB during TLE. Results: In the analysed group, 56 (7.98%) of 702 TLE procedures were disrupted by the breakage of at least one lead. The model showed a lower lead breakage rate in procedures when an atrial lead was simultaneously extracted, a locking stylet was used, and when the procedure was conducted in older patients or those who had undergone prior cardiac surgery. Higher risk of LB was proven in the following cases: the extraction of leads implanted a long time ago; the extraction of VDD-type leads; the extraction of abandoned leads; extraction during a prolonged procedure. Occurrence of lead breakage may lead to pericardial effusion requiring intervention, acute kidney injury, or leaving remnants of the leads. Conclusions: Lead breakage is an underestimated procedural difficulty that can occur during transvenous lead extraction. In this study, several clinical and procedural variables were independently associated with lead breakage. Abandoned leads, VDD leads, and prolonged procedure time were associated with increased risk. In contrast, older age, use of a locking stylet, atrial lead extraction, prior cardiac surgery, and later year of implantation demonstrated independent protective associations.

Background: Venous thrombosis occurring after TLE procedures is a fairly common but poorly described complication and requires further investigation into its causes. Aim: The aim of this study was to identify independent predictors of UEDVT occurrence after TLE procedures. Methods: We analyzed data from 504 transvenous lead extraction procedures performed in the hybrid surgery room of the Department of Electrocardiology and Heart Failure at the Medical University of Silesia, Katowice, Poland, between January 2016 and May 2022. All procedures were performed using mechanical‐only techniques. Results: In the analyzed period, as a result of 504 transvenous extraction procedures of cardiac implantable electronic device leads, 19 (3.8%) cases of symptomatic venous thrombosis of the upper extremity on the side of the procedure occurred. The mean age of patients who developed the complication was 65.8 ± 13.3 years, and 68.4% were men, which did not differ significantly from the general group. Based on variables selected in the univariate analysis, a logistic regression model of risk factors for UEDVT was calculated. These include a history of cancer disease in patients ( p = 0.0110), heart failure according to the Class IV NYHA scale ( p = 0.0397), advanced longest dwell time ( p = 0.0323), extraction of atrial lead ( p = 0.0368), and the use of mechanical non‐powered telescopic sheaths ( p = 0.0455). As protective factors were assessed, infectious indications for TLE ( p = 0.0288) and the highest platelet concentration ( p = 0.0448). Conclusions: Thrombosis is a relatively rare but serious complication. The precise selection of patients at risk of thrombosis after TLE may increase clinical success. It has been shown that an increased risk of thrombosis after TLE occurs in patients with a history of cancer, with heart failure in NYHA Class IV, and platelet concentration is low, in whom TLE is performed for noninfectious reasons, with the use of additional equipment like mechanical non‐powered telescopic sheaths.

Background/Objective: The EXTRACT registry cohort of 504 patients undergoing transvenous lead extraction (TLE) has been previously reported in terms of periprocedural safety and short-term outcomes. Data on long-term mortality and its predictors in this population remain limited. The study aimed to identify risk factors for overall mortality at three years following TLE. Methods: This is a secondary, long-term follow-up analysis of the previously published EXTRACT registry cohort of 504 consecutive patients who underwent TLE between 2016 and 2022. We conducted a univariate analysis to predict mortality risk following TLE, followed by Cox regression with cross-validation to identify independent predictors of mortality over a 3-year follow-up period; Brier score assessed prediction accuracy for mortality; and decision curve analysis evaluated the clinical usefulness of the model. Results: Mortality data were completed for 487 patients at three-year follow-up. Long-term outcomes of TLE showed that patients with CIED infection (p = 0.0091), higher NYHA class (p < 0.0001), arterial hypertension (p = 0.0068), previous stroke (p = 0.0092), upgraded to condition pacing post-TLE (p = 0.0092), and higher CHA₂DS₂-VA score (p = 0.0026) had markedly higher mortality at three-year follow-up. Increased mortality was independently associated with estimated glomerular filtration rate (eGFR) and the CHA₂DS₂-VA score. Risk increased incrementally with each 1 mL/min/1.73 m² decrease in eGFR (hazard ratio, 0.99; 95% CI, 0.98–0.99), and each 1-point increase in CHA₂DS₂-VA conferred a 12% higher mortality rate (hazard ratio, 1.12; 95% CI, 1.02–1.23). Conclusions: In this prospective registry, 3-year mortality after TLE was driven predominantly by baseline clinical risk rather than procedural factors. Renal dysfunction and a higher CHA₂DS₂-VA score independently predicted death, supporting the incorporation of kidney function and global vascular risk into pre-extraction assessment and post-extraction management.