Transvenous Lead Extraction Versus Abandonment of non-Infected, Superfluous Leads—A Meta-Analysis and Systematic Review

Background: Managing non-functional cardiac implantable electronic device (CIED) leads remains controversial. While extraction is standard for infection, it is unclear whether transvenous lead extraction (TLE) or lead abandonment (LA) provides superior outcomes for superfluous leads. Prophylactic TLE may prevent future infection or venous obstruction and avoid complex delayed extraction but carries immediate procedural risk. Conversely, LA avoids upfront risk, though retained leads may predispose to long-term sequelae. Objectives: To compare procedural and clinical outcomes of TLE versus LA for non-infected leads and assess how pre-existing abandoned leads influence the risks of subsequent extraction. Methods: PubMed, Embase, OVID, and Cochrane were searched (2000–2025) for studies comparing TLE versus LA and TLE with versus without abandoned leads. Twenty-three observational studies involving 65,760 patients were included. Data was extracted by two investigators using PRISMA guidelines. Primary outcomes included major complications, in-hospital mortality, and clinical success, pooled as odds ratios with 95% confidence intervals using a random-effects model. Subgroup and meta-regression analyses were performed. Results: TLE was associated with significantly higher odds of major complications (OR 2.07, 95% CI 1.42–3.03) and in-hospital mortality (OR 2.97, 95% CI 1.95–4.53) compared with LA, with no significant long-term difference within limited follow-up. Extraction of previously abandoned leads carried higher risks of major complications (OR 2.51), minor complications (OR 1.79), and mortality (OR 2.06), with lower clinical success (OR 0.24) than functional leads. Recent studies show improved TLE safety. Conclusion: While TLE carried higher immediate risks, measured long-term outcomes were comparable; however, follow-up was insufficient to capture late abandonment-related sequelae. Extraction of previously abandoned leads carried markedly higher risk, supporting earlier extraction in appropriately selected patients.