The leads are still the weakest link

implantable cardioverter-defibrillator lead (1.8%), coronary sinus lead (1.4%) and RV pacing lead (0.3%) [5]. The reason for the consistently high rates of atrial lead dislodgement is unclear. Intuitively, it appears that it could be because the atrial lead is essentially free floating, with less support compared to RV apical leads which are wedged into a narrow space at the apex. It may also be that the extendable helix may not screw as well into the myocardium when in a J-curve versus a straight line. Unfortunately, the present study does not delve into the details of implant parameters. Ghani et al. [5] noted in their study that lead dislodgements could have been prevented by adequate fixation of suture sleeves in one-third of cases. Also, the current of injury at implantation has been shown to predict adequate fixation of leads, but this was not reported in the present study [6].