Abstract
Background. Indications for extraction of an abandoned pacemaker lead (APL) are controversial. The purpose of this study was to determine whether or not APLs should be extracted in the absence of pacemaker-related problems.
Methods and Results. We retrospectively reviewed, from 1977 through 1998, all patients with retained, non-functional leads and identified 433—266 males and 167 females. Mean age at initial pacemaker implantation was 68[emsp4 ]years. These patients received a total of 259 atrial and 948 ventricular leads. Of the total of 1,207 leads, 611 became non-functional. A total of 531 non-functional leads were abandoned, of which 18 were later extracted: one APL in 345 patients, two in 78, and three in 10. Indications for new lead placement when non-functional leads were abandoned included capture and/or sensing failure (243), lead recall (177), lead fracture (86), pacing system replacement to the contralateral side (11), accommodating patient growth (5), pacemaker function upgrade (5), replacement with implantable cardioverter defibrillator (ICD, 2), interference with ICD (1), and unknown (1). Complications that were associated with pacemakers were found in 24 patients (5.5%)—pacemaker 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 pacemaker system to the contralateral side (9). Neither venous thrombosis nor other complications were found in the remaining 409 patients (94.5%). The incidence of complications was higher in patients with three APLs than in patients with two or fewer APLs (40% vs. 4.7%, P=1×10−6), 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<1×10−10), and in patients with three 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=1×10−10). Patients with complications were younger than those without complications both at the time of initial pacemaker implantation (59±16 vs. 68±17[emsp4 ]y, P=0.01) and when non-functional leads were abandoned (63±15 vs. 71±16[emsp4 ]y, P=0.04). Mean numbers of APLs, total leads implanted, and procedures of new lead placement were significantly larger in patients with complications 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, 4×10−9 and 4×10−5, respectively).
Conclusions. 1. With only 5.5% of patients having had pacemaker-related complications, the adverse outcome of APL is small. 2. Clinical clues to the possible occasion for pacemaker-related complications include three or more APLs, four or more total leads, three or more procedures of new lead placement, and a younger age at initial pacemaker implantation. 3. Patients with a large number of APLs, total lead implantations, and procedures of new lead placement should be carefully observed to detect possible pacemaker-associated complications.
Similar content being viewed by others
References
Byrd CL, Schwartz SJ, Hedin NB, Goode LB, Fearnot NE, Smith HJ. Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 1990;13:1871-1875.
Brodell GK, Castle LW, Maloney JD, Wilkoff BL. Chronic transvenous pacemaker lead removal using a unique, sequential transvenous system. Am J Cardiol 1990;66:964-966.
Fearnot NE, Smith HJ, Goode LB, Byrd CL, Wilkoff BL, Sellers TD. Intravascular lead extraction using locking stylets, sheaths, and other techniques. Pacing Clin Electrophysiol 1990;13:1864-1870.
Byrd CL, Schwartz SJ, Hedin N. Intravascular techniques for extraction of permanent pacemaker leads. J Thorac Cardiovasc Surg 1991;101:989-997.
Byrd CL, Schwartz SJ, Hedin N. Lead extraction. Indications and techniques. Cardiol Clin 1992;10:735-748.
Colavita PG, Zimmern SH, Gallagher JJ, Fedor JM, Austin WK, Smith HJ. Intravascular extraction of chronic pacemaker leads: efficacy and follow-up. Pacing Clin Electrophysiol 1993;16:2333-2336.
Smith HJ, Fearnot NE, Byrd CL, Wilkoff BL, Love CJ, Sellers TD. Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. Pacing Clin Electrophysiol 1994;17:2016-2020.
Hayes DL. Extraction of permanent pacing leads: there are still controversies. Heart 1996;75:539-541.
Myers MR, Parsonnet V, Bernstein AD. Extraction of implanted transvenous pacing leads: a review of a persistent clinical problem. Am Heart J 1991;121:881-888.
Furman S, Behrens M, Andrews C, Klementowicz P. Retained pacemaker leads. J Thorac Cardiovasc Surg 1987;94:770-772.
Tallury VK, DePasquale NP, Bruno MS, Nody AC. Migration of retained transvenous electrode catheter. Arch Intern Med 1972;130:390-391.
Theiss W, Wirtzfeld A. Pulmonary embolisation of retained transvenous pacemaker electrode. Br Heart J 1977;39:326-329.
Böhm A, Bányai F, Komáromy K, Pintér A, Préda I. Cerebral embolism due to a retained pacemaker lead: a case report. Pacing Clin Electrophysiol 1998;21: 629-630.
Parry G, Goudevenos J, Jameson S, Adams PC, Gold RG. Complications associated with retained pacemaker leads. Pacing Clin Electrophysiol 1991;14: 1251-1257.
Henderson D, Maher M, Johnson D. Pacemaker inhibition due to anodal ring electrode contact. Pacing Clin Electrophysiol 1995;18:2222-2224.
Toumbouras M, Spanos P, Konstantaras C, Lazarides DP. Inferior vena cava thrombosis due to migration of retained functionless pacemaker electrode. Chest 1982;82:785-786.
Drizin GS, Fein AM, Lippmann ML. Clinical pulmonary embolism from migration of a retained transvenous permanent pacemaker electrode. Crit Care Med 1982;10:788-789.
Das PB, McArthur JD, Gupta RP, Jairaj PS, John S. Migration of retained endocardial pacemaker electrode and its management. Indian Heart J 1974;26: 198-201.
Phibbs B, Marriott HJ. Complications of permanent transvenous pacing. N Engl J Med 1985;312:1428-1432.
Bluhm G, Julander I, Levander-Lindgren M, Olin C. Septicaemia and endocarditis-uncommon but serious complications in connection with permanent cardiac pacing. Scand J Thorac Cardiovasc Surg 1982;16:65-70.
Rettig G, Doenecke P, Sen S, Volkmer I, Bette L. Complications with retained transvenous pacemaker electrodes. Am Heart J 1979;98:587-594.
Choo MH, Holmes DR Jr, Gersh BJ, Maloney JD, Merideth J, Pluth JR, Trusty J. Permanent pacemaker infections: characterization and management. Am J Cardiol 1981;48:559-564.
Corman LC, Levison ME. Sustained bacteremia and transvenous cardiac pacemakers. JAMA 1975;233: 264-266.
DeLeon SY, Bojar R, Koster NK, Ilbawi MN, Munez H, Idriss FS. Recurrent sepsis from retained endocardial electrode in children: successful removal with cardiopulmonary bypass. Pacing Clin Electrophysiol 1984;7: 166-168.
Hermann W, Hoffer H, Stenzl W, Tscheliessnigg KH. Recurring pulmonary embolism after migration of a retained transvenous pacemaker electrode. Thorac Cardiovasc Surg 1979;27:375-377.
Garcia-Jimenez A, Botana Alba CM, Gutierrez Cortes JM, Galban Rodriguez C, Alvarez Dieguez I, Navarro Pellejero F. Myocardial rupture after pulling out a tined atrial electrode with continuous traction. Pacing Clin Electrophysiol 1992;15:5-8.
Furman S, Escher DJ. Retained endocardial pacemaker electrodes. J Thorac Cardiovasc Surg 1968; 55:737-740.
Robboy SJ, Harthorne JW, Leinbach RC, Sanders CA, Austen WG. Autopsy Ændings with permanent pervenous pacemakers. Circulation 1969;39:495-501.
Yarnoz MD, Attai LA, Furman S. Infection of pacemaker electrode and removal with cardiopulmonary bypass. J Thorac Cardiovasc Surg 1974;68:43-46.
Chavez CM, Conn JH. Septicemia secondary to impacted infected pacemaker wire. Successful treatment by removal with cardiopulmonary bypass. J Thorac Cardiovasc Surg 1977;73:796-800.
Shimizu H, Yozu R, Ueda T, Goto T, Soma Y, Kawada S. Removal of infected total pacemaker system under extracorporeal circulation-a case report and review of the Japanese literature [Japanese]. Nippon Kyobu Geka Gakkai Zasshi 1994;42:160-165.
Zerbe F, Ponizynski A, Dyszkiewicz W, Ziemianski A, Dziegielewski T, Krug H. Functionless retained pacing leads in the cardiovascular system. A complication of pacemaker treatment. Br Heart J 1985;54: 76-79.
Marti V, Gurgui M, Padro JM, Oter R, Rodriguez O. Complications associated with nonfunctioning pacemaker electrodes retained within the cardiovascular system [Spanish]. Rev Esp Cardiol 1994;47:81-85.
Shennib H, Chiu RC, Rosengarten M, Blundell P, Scott H, Mulder DS. The nonextractable tined endocardial pacemaker lead. Can J Cardiol 1989;5:305-307.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Suga, C., Hayes, D.L., Hyberger, L.K. et al. Is There an Adverse Outcome From Abandoned Pacing Leads?. J Interv Card Electrophysiol 4, 493–499 (2000). https://doi.org/10.1023/A:1009860514724
Issue Date:
DOI: https://doi.org/10.1023/A:1009860514724