Do abandoned leads pose risk to implantable cardioverter-defibrillator patients?
BACKGROUND
With the increased number of implantable cardioverter-defibrillator (ICD) recipients and the frequent need for device upgrading, lead malfunction is a concern, but the optimal approach to managing nonfunctioning leads is unknown.


OBJECTIVE
The purpose of this study was to determine the rate and characteristics of complications related to abandoned ICD leads.


METHODS
Patients with abandoned leads were identified by retrospective review of the Mayo Clinic ICD database from August 1993 to May 2002. We reviewed the medical records to assess long-term follow-up for venous thromboembolic complications, device sensing malfunction, appropriateness of delivered shocks, defibrillation threshold (DFT) values before and after lead abandonment, and subsequent surgical procedures related to devices or leads.


RESULTS
We identified 78 ICD patients (81% males; mean age 63 +/- 14 years) with 101 abandoned leads (69 in the right ventricle, 31 in the right atrium or superior vena cava, 1 in the coronary sinus). During a mean follow-up of 3.1 +/- 2.0 years, neither sensing malfunction nor venous thromboembolic complications were detected. DFT values were high in 13 patients (17%), but there was no significant increase in mean DFT values before and after lead abandonment in 43 patients for whom both values were available (16.2 +/- 9.2 J before abandonment vs 14.1 +/- 5.5 J after; P = .24). Fourteen patients (18%) required further ICD-related surgery; none of these operations were attributed to abandoned leads. Five-year rates of appropriate and inappropriate shocks were 25.9% and 20.5%, respectively.


CONCLUSIONS
Abandoning a nonfunctioning lead appears to be safe and does not pose a clinically significant additional risk of future complications.
Glikson
Michael
M
Sheba Medical Center and Tel Aviv University, Tel Hashomer, Israel.
Suleiman
Mahmoud
M
Luria
David M
DM
Martin
Marjorie L
ML
Hodge
David O
DO
Shen
Win-Kuang
WK
Bradley
David J
DJ
Munger
Thomas M
TM
Rea
Robert F
RF
Hayes
David L
DL
Hammill
Stephen C
SC
Friedman
Paul A
PA
D001145:Arrhythmias, Cardiac / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000295:instrumentation*; D004699:Endocardium / Q000601:surgery*; D004867:Equipment Design; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors