A new study revealed that abandoning a nonfunctioning lead in an implantable cardioverter defibrillator (ICD) patient is safe and does not pose a clinically significant risk of complication.
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. The new study published in the January edition of the HeartRhythm Journal (Heart Rhythm Society), suggests that the practice of abandoning nonfunctioning leads does not result in additional risk to the patient and lead extraction should be reserved for cases of system infection or when large numbers of leads have been abandoned.
The study, led by Dr Paul Friedman, Mayo Clinic in Rochester, USA, in collaboration with Dr Michael Glikson, Sheba Medical Center and Tel Aviv University, was designed to examine the outcomes of lead abandonment and whether or not abandoning the lead posed significant risk. Patients for the study were identified by retrospective review of the Mayo Clinic ICD database; data between August 1993 and May 2002 was 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.
“Knowing how to best handle nonfunctioning leads is important, since the number of implantable cardioverter defibrillator recipients is large and growing, and the component most likely to fail is the lead,” stated Friedman. “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.”
The study identified 78 ICD patients – 81% males with an average age of 63 years old – with a total of 101 abandoned leads, some patients with more than one. During a mean follow-up of approximately three years, outcomes of abandoned leads show 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% and 20.5% respectively, were the same as rates seen prior to lead abandonment.
The study concludes that the strategy of abandoning leads does not prove to be harmful to most patients.