Outcome of young patients with abandoned, nonfunctional endocardial leads

Transvenous leads may fail and may be extracted or abandoned. There are no reports of the outcome of children with abandoned nonfunctional leads.

We evaluated retrospectively the outcome of these patients, in our population of pacemaker (PM) patients. Data are reported as median (range).

In 18 patients (of 245, 7%) with endocardial pacing systems implanted at 4 (0.3-19) years of age (15 VVIR and 3 DDD PM), 19 leads (16 ventricular, 3 atrial) failed (abnormal threshold increase in seven leads; exit block in nine including three atrial leads; insulation break in three) after 10 (3-15) years, and were abandoned. At 13 (6-30) years of age, seven patients received VDD PM, seven VVIR, three DDD, and one patient an epicardial system. Median number of abandoned leads is one (two in two patients). Final cross-sectional area (CSA) of the implanted leads is eight (2-14) mm(2). All the procedures were successfully completed. Follow-up (FU) duration is 4 (1-10) years. All new leads are functioning normally. No tricuspid valve dysfunction or new venous occlusion occurred. Two cases of lead endocarditis occurred after 5 and 10 years of follow-up in patients with two ventricular leads. No specific risk factors for endocarditis were identified.

Abandonment of a nonfunctioning lead is a palliative procedure, technically feasible, with no short-term complication. Two patients experienced late endocarditis of the leads.