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.