Pediatric and Adult Congenital Endocardial Lead Extraction or Abandonment Decision (PACELEAD) Survey of Lead Management

BACKGROUND: Nonfunctional, dysfunctional, recalled, or additional endocardial leads in pediatric and congenital heart disease patients pose significant challenges for management. There are no set standards for lead extraction in this patient population. METHODS: Physician members of the Pediatric and Adult Congenital Electrophysiology Society (PACES) were contacted via e-mail and invited to respond to a 33-question online Pediatric and Adult Congenital Endocardial Lead Extraction or Abandonment (PACELEAD) survey. RESULTS: Responses were received from 75 of 138 (54%) physician members of PACES. Institutional volumes of device placement (<25 devices/year for 51% of responders), patients with abandoned leads (<25 patients for 71%), and lead extractions (<10 extractions/year for 51% and no extractions for 29%) were low for the majority of responders. Personal experience with lead extraction was also minimal with 49% not performing the procedure and 39% with less than 40 leads extracted as primary operator. Most responders (54, 72%) refer their lead extractions to another practitioner or facility with more experience. Responders were more likely to recommend lead extraction (>70%) for class IIa indications such as bacteremia, chronic pain that is not medically manageable, and functional leads with ipsilateral venous occlusion. Lead abandonment was favored (>70%) for one class IIb indication, a functional lead that is not currently being used. CONCLUSIONS: Optimal lead management is challenging in pediatric and congenital heart disease patients, and considerable variability of practice is reported in their care. Low institutional and personal volumes may account for this variability.