Abandoning a nonfunctioning lead in an ICD patient is safe and does not pose a clinically significant risk of complication. Lead extraction should be reserved for cases of system infection or when large numbers of leads have been abandoned, according to a study in the January issue of the Heart Rhythm Journal.
Paul Friedman, MD, from the division of cardiovascular diseases at the Mayo Clinic in Rochester, Minn., in collaboration with Michael Glikson, MD, of Sheba Medical Center and Tel Aviv University, retrospectively identified patients for the study from the Mayo Clinic ICD database. Data between August 1993 and May 2002 were reviewed.
Patient medical records were reviewed to see whether with long-term follow-up abandoned intravenous leads increased the risk of venous thromboembolic events, device sensing malfunction, inappropriate shocks and elevated defibrillation threshold values.
The rate of appropriate and inappropriate therapies and defibrillation thresholds were compared before and after lead abandonment. Previously, there had been concern that abandoned leads might interfere with defibrillator function, according to Friedman.
“Knowing how to best handle nonfunctioning leads is important, since the number of ICD recipients is large and growing, and the component most likely to fail is the lead,” Friedman said. “Because removing nonfunctioning leads includes a small risk of tearing great vessels, injuring heart valves and death, we sought to determine whether abandoning leads is safe. For most patients, it is.”
Study methods identified 78 ICD patients with a total of 101 abandoned leads. During a mean follow-up of approximately three years, outcomes of abandoned leads showed no sign of sensing malfunction or symptomatic venous thromboembolic complications. In addition, the study demonstrated that the five-year rates of appropriate and inappropriate shocks, 25.9 percent and 20.5 percent, respectively, were the same as rates seen prior to lead abandonment.
When a lead malfunctions or stops working, there has been uncertainty and disagreement about whether to cap the lead and leave it in place or extract the lead. However, this study concludes that the strategy of abandoning leads does not prove to be harmful to most patients, Friedman said.