Reuters Health reports that if a patient has a pacemaker or defibrillator, they are twice as likely to have life-threatening complications when having them removed if old wiring was left behind during previous procedures to replace or upgrade their device.
There was a U.S. study done that analyzed surgery outcomes for 1,386 patients that were having their heart device removed due to infections, including a subset of 323 people who had abandoned leads – the wires that deliver the energy from pacemakers and defibrillators to the heart.
Researchers looked at extractions data from August 1996 to September 2012 at Cleveland Clinic. The abandoned leads procedures took longer and had more complications. The surgery for the abandoned leads patients lasted from 130 to 220 minutes, and the surgery for the patients without old wiring lasted 85 to 155 minutes.
Further, results showed that doctors were unable to remove the devices and all of the leads without serious complication in 13 percent of patients who had abandoned wires – this is compared to 3.7 percent of patients without abandoned leads.
The complications during and after surgery for the abandoned leads were: 0.9 percent suffered cardiac perforations compared to 0.09 percent of those without abandoned leads, 3.7 percent required a transfusion compared to 0.9 percent without abandoned leads, and 3.7 percent had to be taken to the intensive care unit compared to 1.4 percent without abandoned leads. After one month, 7.4 percent of the patients with abandoned leads had died, compared to 3.5 percent of the patients without abandoned leads.
In the United States alone, 300,000 patients receive new pacemakers and defibrillators each year, and most of these patients will need operations to upgrade or replace those devices in the future, which can result in infection.
Device infection is a life threatening condition with a 66 percent chance of death if left untreated.
The study is observational, so it cannot prove that abandoned leads directly causes complications or deaths, only that these events are more likely. However, the findings of the study show the need for increased awareness about the risks associated with abandoned leads, Dr. David Wilber mentioned.
He also pointed out that many people are not aware that there is increased risk and that removal of nonfunctioning leads requires special skills that most device implanters do not have. Patients who are older or are ill may very likely decline removal of abandoned leads because of the risk.
It is recommended that patients find out how much experience their physician has with this procedure and with infected leads because even the best surgeons involved in these procedures are occasionally challenged by difficult circumstances.
Dr. John Fisher stated that experience, careful surgical technique, and longer lasting devices that reduce the need for replacement due to batteries are all effective ways to reduce infection.