January 6, 2009 - New research published in the January edition of the HeartRhythm Journal reveals that abandoning a nonfunctioning lead in an ICD patient is safe and does not pose a clinically significant risk of complication.
The new study published also suggests lead extraction should be reserved for cases of system infection or when large numbers of leads have been abandoned.
The study was led by Paul Friedman, M.D., Division of Cardiovascular Diseases at the Mayo Clinic in Rochester, MN in collaboration with Michael Glikson, M.D., of Sheba Medical Center and Tel Aviv University. The study examined 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 with data between August 1993 and May 2002 reviewed. Patient medical records were reviewed to see whether with long-term follow-up abandoned intravenous leads increased the risk of venous thromboembolic events (vein clotting), 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 ICD recipients is large and growing, and the component most likely to fail is the lead,"? stated Dr. 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."
Study methods identified 78 ICD patients - 81 percent 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. The study also demonstrated the five-year rates of appropriate (25.9 percent) and inappropriate shocks (20.5 percent), 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.
For more information: www.heartrhythmjournal.com.