We studied the incidence of lead fractures in 2,226 patients with a total follow-up period of 8,558 patient years. Lead fractures occurred in 100 out of 2,563 implanted leads (3.9%). This corresponds to an average rate of 1.2% per patient year. We found 62 out of 881 singlefilar coil leads fractured (7.0%), 20 out of 809 Siemens Elema 588 leads (2.5%) and only 6 out of 630 multifilar soil leads (1.0%). Lead fractures occurred at a significantly (p less than 0.05) higher rate in singlefilar coil leads than in Simens Elema 588 leads or in multifilar coil leads. Independent of the type of lead, a significantly (p less than 0.05) higher fracture rate was found with leads implanted through the internal jugular vein. Most fractures occurred either inside the pacemaker pocket or on the way from the connector to the venous entry. Only 7% of all fractures occurred within the vascular system. Patients with a second or third degree AV-block and a multifilar coil lead implanted showed a significantly (p less than 0.05) better survival rate compared to those with a singlefilar coil or a Siemens Elema 588 lead. In pacemaker-dependent patients a replacement of singlefilar coil leads might be considered.