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BACKGROUND Long-term outcomes are poorly understood, and data in patients undergoing transvenous lead extraction (TLE) are lacking.OBJECTIVE The purpose of this study was to evaluate factors influencing survival in patients undergoing TLE depending on extraction indication.METHODS Clinical data from consecutive patients undergoing TLE in the reference center between 2000 and 2019 were prospectively collected. The total cohort was divided into groups depending on whether there was an infective or noninfective indication for TLE. We evaluated the association of demographic, clinical, and device-related and procedure-related factors on mortality.RESULTS A total of 1151 patients were included. Mean follow-up was 66 months, and mortality was 34.2% (n 5 392). Of these patients, 632 (54.9%) and 519 (45.1%) were for infective and noninfective indications, respectively. A higher proportion in the infection group died (38.6% vs 28.5%; P ,.001). In the total cohort, multivariable analysis demonstrated increased mortality risk with age .75 years (hazard ratio [HR] 2.98; 95% confidence interval [CI] 2.35-3.78; P ,.001), estimated glomerular filtration rate ,60 mL/min/1.73 m 2 (HR 1.67; 95% CI 1.31-2.13; P ,.001), higher cumulative comorbidity (HR 1.17; 95% CI 1.09-1.26; P ,.001), reduced risk per percentage increase in left ventricular ejection fraction (HR 0.98; 95% CI 0.97-0.99; P ,.001), and near unity per year of additional lead dwell time (HR 0.98; 95% CI 0.96-1.00; P 5 .037). Kaplan-Meier survival curves demonstrated worse prognosis, with a higher number of leads extracted and increasing comorbidities.CONCLUSION Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests also assessing longer-term outcomes when considering TLE in those with a high risk of medium-and longterm mortality, particularly for noninfective indications.