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Transvenous Defibrillation Leads: High Incidence of Failure During Long‐Term Follow‐Up
Author(s) -
DORWARTH UWE,
FREY BERNHARD,
DUGAS MARTIN,
MATIS TOMAS,
FIEK MICHAEL,
SCHMOECKEL MICHAEL,
REMP THOMAS,
DURCHLAUB ILKA,
GERTH ANDREA,
STEINBECK GERHARD,
HOFFMANN ELLEN
Publication year - 2003
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2003.02305.x
Subject(s) - medicine , defibrillation , ventricular fibrillation , defibrillation threshold , lead (geology) , implantable cardioverter defibrillator , ventricular tachycardia , cardiology , incidence (geometry) , shock (circulatory) , surgery , physics , geomorphology , optics , geology
Implantable Defibrillator Lead Failure. Introduction: Patients with implantable cardioverter defibrillators (ICD) critically depend on correct functioning of their system. The aim of this study was to determine the incidence and clinical presentation of transvenous ICD lead failures during long‐term follow‐up.Methods and Results: The study group consisted of 261 consecutive patients who received Medtronic right ventricular polyurethane transvenous leads (models 6884, 6966, 6936) between 1990 and 1998 as part of an abdominal(n = 70)or pectoral(n = 191)ICD system. During mean follow‐up of4.0 ± 2.6 years, 31 patients (12%) developed a lead‐related sensing failure with oversensing of artifacts. All failures except two were compatible with an insulation defect and occurred late after ICD placement (6.0 ± 1.8 yearsafter implant). Lead survival decreased from 98% at 4‐year follow‐up to only 62% at 8‐year follow‐up. Lead survival was not related to patient age, sex, venous lead implantation route, or device implantation site. In 26 (87%) of 31 patients, a sensing defect resulted in inappropriate detection of ventricular fibrillation and subsequent delivery of3 ± 3(range 1–11) inappropriate shocks in 19 (61%) of 31 patients. Device interrogation showed artifacts classified as nonsustained ventricular tachycardia in 21 patients,40 ± 43 daysbefore clinically relevant failure of the system. One patient with a subclavian crush syndrome required resuscitation because of undersensing of true ventricular fibrillation.Conclusion: Transvenous polyurethane ICD leads showed a high rate of lead insulation failure late after implantation with frequent inappropriate shock deliveries. Close follow‐up is mandatory in patients with these leads. Automated device control features with patient alert function integrated into new devices may contribute to early detection of lead failure.