Long-term follow up of ventricular endocardial pacing leads. Complications, electrical performance, and longevity of 561 right ventricular leads.

Five hundred and sixty-one endocardial pacing leads implanted in the right ventricle of 502 patients between 1971 and 1990 were followed for up to 17 years regarding their complications, stimulation threshold behavior, and overall longevity. Lead tip dislodgment occurred in 16 leads (2.9%), in 14 of which dislodgement occurred within 2 months after implantation. The incidence of dislodgement was significantly smaller in tined leads than in nontined leads. Lead conductor fracture occurred in 19 leads (3.4%), in 15 of which fracture occurred within 5 years after implantation. Two particular sites of lead fracture were identified; i.e., one within the pacemaker pocket and the other at a particular point in the subclavian vein between the clavicle and the first rib. Fixation ligature in the former site and the venopuncture point for lead insertion in the latter site are thought to be related to lead fracture. Other complications included insulator break in 3 leads (0.5%), exit block in 7 leads (1.2%), and poor sensing in 2 leads (0.4%). The cumulative survival of leads was 94.1 +/- 2.7% (mean +/- 95% confidence interval) at 5 years, 86.3 +/- 6.3% at 10 years, and 74.2 +/- 14.0% at 15 years after implantation. The minimal stimulation threshold, lead impedance and R wave amplitude were all found to be stable for up to 10 years, and there were no tendencies toward higher stimulation threshold during the observation period of this study.