Is there an adverse outcome from abandoned pacing leads?

Background. Indications for extraction of an abandoned pacemaker lead (APL) are controversial. The purpose of this study was to determine whether or n ot APLs should be extracted in the absence of pacemaker-related problems. Methods and Results. We retrospectively reviewed, from 1977 through 1998, a ll patients with retained, non-functional leads and identified 433-266 male s and 167 females. Mean age at initial pacemaker implantation was 68 years. These patients received a total of 259 atrial and 948 ventricular leads. O f the total of 1,207 leads, 611 became non-functional. A total of 531 non-f unctional leads were abandoned, of which 18 were later extracted: one APL i n 345 patients, two in 78, and three in 10. Indications for new lead placem ent when non-functional leads were abandoned included capture and/or sensin g failure (243), lead recall (177), lead fracture (86), pacing system repla cement to the contralateral side (11), accommodating patient growth (5), pa cemaker function upgrade (5), replacement with implantable cardioverter def ibrillator (ICD, 2), interference with ICD (1), and unknown (1). Complicati ons that were associated with pacemakers were found in 24 patients (5.5%)-p acemaker system infection (8 patients) and venous occlusion at the time of a subsequent procedure of new lead placement when APLs had already been in place (16) which resulted in APL extraction (7) or transfer of the pacemake r system to the contralateral side (9). Neither venous thrombosis nor other complications were found in the remaining 409 patients (94.5%). The incide nce of complications was higher in patients with three APLs than in patient s with two or fewer APLs (40% vs. 4.7%, P=1x10(-6)), in patients with four or more total lead implantations than in patients with three or fewer total lead implantations (26.2% vs. 0.6%, P < 1x10(-10)), and in patients with t hree or more procedures of new lead placements than in patients with two or fewer procedures of new lead placements (36.4% vs. 3.9%, P=1x10(-10)). Pat ients with complications were younger than those without complications both at the time of initial pacemaker implantation (59 +/- 16 vs. 68 +/- 17 y, P=0.01) and when non-functional leads were abandoned (63 +/- 15 vs. 71 +/- 16 y, P=0.04). Mean numbers of APLs, total leads implanted, and procedures of new lead placement were significantly larger in patients with complicati ons than in those without complications (1.58 +/-0.78 vs. 1.2 +/-0.44, 4.96 +/-1.23 vs. 2.66 +/-0.8, and 2.13 +/-0.85 vs. 1.25 +/-0.53, P=0.03, 4x10(- 9) and 4x10(-5), respectively). Conclusions. 1. With only 5.5% of patients having had pacemaker-related com plications, the adverse outcome of APL is small. 2. Clinical clues to the p ossible occasion for pacemaker-related complications include three or more APLs, four or more total leads, three or more procedures of new lead placem ent, and a younger age at initial pacemaker implantation. 3. Patients with a large number of APLs, total lead implantations, and procedures of new lea d placement should be carefully observed to detect possible pacemaker-assoc iated complications.