The nonextractable tined endocardial pacemaker lead

With the advent of the tined pacemaker electrode to improve endocardial fixation, increasing difficulty in extracting them when needed has resulted in reports of serious complications. The authors reviewed their experience between January 1975 and January 1985. During this 10 year period, 942 pacemakers were inserted and 73 were reoperated upon. In the reoperations, repositioning or removal of tined electrodes was attempted 28 times. Repositioning or removal was not possible in 12 of the 28 cases (43%). In 22 of 28, the attempts to remove tined leads were carried out more than one month after the original implantations and in this group the failure rate was 54.5% (12 of 22). All attempts of removal within one month of implantation were successful (six of six). No leads were retained during the period between January 1984 and January 1985. All 12 retained leads were followed-up for five years, five of which were retained in the presence of pacemaker pocket infections. After removal of the power pack and lead distal to the cephalic or subclavian vein inlet, control of infection was achieved in all five cases. One patient was noted to have the retained lead migrate into the right pulmonary artery but was asymptomatic at 35 months after catheter migration was detected. Until now, no thoracotomy for lead extraction has been required in this series.(ABSTRACT TRUNCATED AT 250 WORDS)