Lead Abandonment versus Lead Extraction for Non-Functional Implantable Cardiac Devices: A Meta-analysis

Background
There is an exponential increase in the use of Cardiovascular Implantable Electronic Device (CIED) with 4.5 million active devices and >1 million new leads implanted annually. With the advent of CIEDs, incidence of device related replacement and complications have increased as well. Nonfunctional CIED leads can be managed by either lead abandoning or extraction. However, which method has long-term safety profile is a matter of debate. The aim of this study to answer whether lead abandoning is a safer alternative to current standard of care of explantation of lead when indicated.

Methods
PubMed, Cochran, Science direct and Google Scholar databases were comprehensively searched through October 2018 to identify clinical trials and other studies comparing the outcomes in patients’ undergoing lead extraction (LE) versus lead abandonment (LA). For efficacy, all cause mortality at end of one, two and five years were compared. For safety, rate of device infection was compared. Effect size of each study was computed and compared using random-effect, Mantel-Haenszel method.

Results
Four cohort studies with a total of 7959 patients with lead abandonment (6293) and lead extraction (1666), met the eligibility criteria to be included in the analysis. The rate of device infections was not significantly lower in patients with LA versus LE with OR 0.64 (0.35, 1.17), p= 0.15. The all-cause mortality was non-significant between the two groups for years one and two with OR 0.76 (0.45, 1.29), p= 0.31 and 0.87 (0.61, 1.24), p= 0.44; respectively. However, at 5 years all-cause mortality was significantly higher in patients with LA vs LE with OR 1.26 (1.11, 1.43), p= 0.0003.

Conclusions
No significant difference was observed between the two cohorts for rate of device infections. In select patients with significant co-morbidities, lead abandoning may be a better choice since there is not much difference in mortality for up to first couple of years. For younger patients and patients with longer life expectancy, LE is better than LA since the mortality is higher at five years for patients with LA.