Is Abandonment of Failed Implanted Leads Associated with an Increased Risk of Long-Term Complications?

Abstract

Background: Failure of a cardiac implantable electronic device lead can be treated by either lead abandonment or extraction. There is a paucity of long-term outcome data comparing these two management strategies. Objective: To assess the long-term outcomes of a cohort of patients with abandoned leads compared to extracted leads. Methods: We conducted a retrospective review of consecutive patients with an endocardial lead abandoned or extracted at our centre between February 2000 and 2018. Results: A total of 329 inactive leads in 282 patients were identified; 195 were abandoned, 134 extracted. Patients who underwent lead extraction were younger (58{±}16 vs. 72{±}13 years) had less hypertension (34% vs. 59%), diabetes (10% vs. 19%), coronary artery disease (26% vs. 38%), atrial fibrillation (34% vs. 56%) and were more likely to have a high voltage device (46% vs. 12%). Four of 159 patients in whom leads were initially abandoned underwent subsequent extraction, one for late endocarditis. Subsequent event rates were similar between the abandoned and extracted groups; endocarditis (0.6% vs. 0.8%), venous thrombosis (2.5% vs. 1.6%), occluded venous access at subsequent procedure (2.5% vs. 2.4%), inappropriate therapy (1.3% vs. 1.6%) and failure of therapy (0.6% vs. 1.6%). In a multivariate model there was no increase in risk of the combined endpoint of mortality and late complications in patients managed by lead abandonment (OR 1.05, CI 0.57-1.82). Conclusions: In our cohort of patients with a discretionary indication for either lead extraction or abandonment, similar outcomes were observed with either strategy.