Outcomes of Transvenous Lead Extraction for Infectious Versus Non‐Infectious Indications

Abstract Background: Transvenous lead extraction (TLE) is performed for both infectious and non‐infectious cardiac implantable electronic device (CIED) indications. Infectious indications are associated with greater systemic illness, whereas non‐infectious leads are generally older and more fibrotic. Whether these competing factors differentially influence TLE outcomes remains unclear. Methods: We searched PubMed, Embase, Scopus, and CENTRAL through October 10, 2026 for studies directly comparing TLE outcomes between infectious and non‐infectious indications. Trial registries, conference abstracts, and preprint servers were screened. The primary outcome was all‐cause mortality. Secondary outcomes included procedural success and complications. Random‐effects models were used. Results: Fifteen observational studies comprising 53,086 patients were included. Infectious indications were associated with higher all‐cause mortality (OR 5.61, 95% CI 3.78–8.33; I 2 = 82.3%). The association was greater for short‐term than long‐term mortality (OR 8.57 vs. 2.67; p for interaction < 0.001). Intermediate‐term mortality was also higher (OR 3.84, 95% CI 2.50–5.91). Pericardial complications were less frequent with infectious indications (OR 0.71, 95% CI 0.53–0.95). Clinical and complete procedural success and other complications did not differ significantly. Conclusion: Infectious indications were associated with higher mortality, particularly in the short term, whereas procedural success was comparable. Variation in follow‐up and infection phenotype likely contributed to heterogeneity.