Abandoned Leads Do Not Pose a Risk to ICD Patients
Lead extraction should be reserved for specific cases according to a new study published in the HeartRhythm Journal

FOR IMMEDIATE RELEASE
Contact: Ann-Marie White
Heart Rhythm Society
(202) 464-3476
awhite@hrsonline.org

WASHINGTON, DC — New research reveals that abandoning a nonfunctioning lead in an ICD patient is safe and does not pose a clinically significant risk of complication. The lead is the wire placed in the heart that transmits the heart's electrical signals to the defibrillator for interpretation. The new study published in the January edition of the HeartRhythm Journal, the official journal of the 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 Paul Friedman, MD, 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, 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 (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. 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.

For more information about this study, please visit www.heartrhythmjournal.com.

About HeartRhythm Journal
HeartRhythm, the official journal of the Heart Rhythm Society, provides rapid publication of the most important science developments in the field of arrhythmias and cardiovascular electrophysiology (EP). As the official journal of the Heart Rhythm Society, HeartRhythm publishes both basic and clinical subject matter of scientific excellence devoted to the EP of the heart and blood vessels, as well as therapy. The journal is the only EP publication serving the entire electrophysiology community from basic to clinical academic researchers, private practitioners, technicians, industry and trainees. HeartRhythm has a new impact factor of 4.203 for 2007 and ranks 10th out of 72 cardiovascular medicine journals by the Institute for Scientific Information. Additionally, the journal ranks seventh in the Immediacy Index among cardiology publications. It is also the official publication of the Cardiac Electrophysiology Society.