Is there a need to remove an old pacemaker when implanting a new device in the contralateral side?

Background: Device replacement or revision may constitute 25% of pacemaker procedures. In patients needing pacemaker system replacement the usual approach is from the ipsilateral side of the previous system. In cases where the contralateral side is used the previous pulse generator is removed. Objective: To test the feasibility of implanting a new system in the contralateral side without the removal of the old system. Methods: We present 10 patients, age range 30-88 years (median 73), with clinical indication of pacemaker replacement where the contralateral side was used. In eight patients the replacement was lead-related, and in the remaining two was due to other clinical indications. In all cases the ipsilateral approach was felt to be contraindicated because of local vein and/or pocket complications. Following the new pacemaker implantation the old system was reprogrammed at the lowest rate, lowest output and highest sensitivity. Results: All patients underwent uneventful implantation. Postsurgery monitoring and Holter recordings failed to show any interference by the old system. Conclusions: In clinically indicated cases it is feasible to implant a new device in the contralateral side without removing the old pulse generator, thereby avoiding an additional surgical procedure and reducing periprocedural complications.