Background
As a result of growing life expectancy and broadening indication, there has been a significant increase in the proportion of cardiac implantable electronic device (CIED) with consequent increase of infection rate, prevalence of comorbid and frail recipients, lead dysfunction, system revisions and upgrade (1–3). Thus, transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy (4), dealing with a continuously increasing demand (5). Nonetheless, literature about the long-term follow-up of patients undergoing TLE is still lacking. In particular, short-term safety and efficacy of TLE have been extensively investigated (2,6,7), while reports on very long-term outcomes after TLE are still limited and particularly focused on infection-related predictors of mortality (8–15). Moreover, there is evidence in the scientific literature of substantial costs associated with extraction and reimplantion procedures (16). Given these knowledge gaps, the aim of our study was to provide a careful analysis of very long-term mortality from a single high-volume tertiary referral center for TLE, in a public health perspective, with regard to the sustainability of TLE procedure and clinical follow-up. In addition to that, we evaluated and reported the costs of CIED extraction and reimplantation in a long term follow-up perspective.