Is there a need to remove an old pacemaker when implanting a new device in the contralateral side?
BACKGROUND
Device replacement or revision may constitute 25% of pacemaker procedures. In patients needing pacemaker system replacement the usual approach is from the ipsilateral side of the previous system. In cases where the contralateral side is used the previous pulse generator is removed.


OBJECTIVE
To test the feasibility of implanting a new system in the contralateral side without the removal of the old system.


METHODS
We present 10 patients, age range 30-88 years (median 73), with clinical indication of pacemaker replacement where the contralateral side was used. In eight patients the replacement was lead-related, and in the remaining two was due to other clinical indications. In all cases the ipsilateral approach was felt to be contraindicated because of local vein and/or pocket complications. Following the new pacemaker implantation the old system was reprogrammed at the lowest rate, lowest output and highest sensitivity.


RESULTS
All patients underwent uneventful implantation. Post-surgery monitoring and Holter recordings failed to show any interference by the old system.


CONCLUSIONS
In clinically indicated cases it is feasible to implant a new device in the contralateral side without removing the old pulse generator, thereby avoiding an additional surgical procedure and reducing periprocedural complications.
Iakobishvili
Zaza
Z
Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel.
Kusniec
Jairo
J
Mazur
Alexander
A
Battler
Alexander
A
Strasberg
Boris
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016896:Treatment Outcome