Is the use of an additional pace/sense lead the optimal strategy for the avoidance of lead extraction in defibrillation lead failure? A single-centre experience

Aims The implantation of an additional pace-sense (P/S) lead is a standard treatment option in the management of an isolated pace-sense problem in a defibrillation (HV-P/S) lead. However, the safety of this management strategy is unclear. We performed a retrospective single-centre study to assess this. Methods and results We studied all patients with an isolated P/S problem in an HV-P/S lead, treated with an additional P/S lead, in our institution. The need for further invasive intervention for a lead-related complication, or death during follow-up, was assessed. From 2000 to 2008, 45 patients were treated with an additional P/S lead. Mean follow-up was 78 +/- 38 months from original device implantation and 28 +/- 17 months following implantation of the additional lead. During follow-up, three patients required an invasive intervention for a lead-related problem. All were successfully treated with lead extraction and device re-implantation. There were five deaths. Following implant of an additional lead, cumulative survival from further lead defects after 6 months, 1, 2, and 3 years was 100, 100, 93, and 87%, respectively. Conclusion In the treatment of an isolated P/S problem in an HV-P/S lead, the placement of an additional P/S lead is a safe management strategy, at least in the short term.