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Management Strategies When Implanted Cardioverter Defibrillator Leads Fail: Survey Findings
Author(s) -
XU WENJIE,
MOORE HANS J.,
KARASIK PAMELA E.,
FRANZ MICHAEL R.,
SINGH STEVE N.,
FLETCHER ROSS D.
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02454.x
Subject(s) - pace , medicine , implantable cardioverter defibrillator , cardiac resynchronization therapy , lead (geology) , implant , medical emergency , heart failure , cardiology , surgery , ejection fraction , geodesy , geomorphology , geology , geography
Background:Defibrillator implanters have adopted different approaches to managing failures of multicomponent implanted cardioverter defibrillator (ICD) leads. Although recent publications identified single‐component failures as common mechanisms of failure, there are no published data regarding how best to manage these failures.Methods:An internet‐based survey was conducted to identify current management strategies. Questions were asked regarding isolated failure of a high‐voltage coil or of a pace/sense electrode, in order to identify the frequency of various techniques to correct these failures.Results:A worldwide query collected strategies from 376 physicians identifying themselves as ICD‐implanting physicians. Replies came from 28 countries, with the USA accounting for 83.2%. The survey was completed by 85.6% of respondents. Implant experience was >10 years for 61.1%, 3–10 years for 29.1%, and <3 years for 10.4%. When the right ventricular coil failed, 52% abandoned and 48% explanted the failed lead. In superior vena cava coil failure, 61.2% chose to simply exclude this coil, using the other intact lead components. For pace/sense defects, 53.1% chose to implant a new pace/sense lead or switch sensing electrodes, using the intact lead components. Medical literature (76.1%), personal experience (67.6%), and professional guidelines (63.7%) were strong decision‐making influences.Conclusions:(1) Management decisions for single‐component failures of ICD leads are complex; (2) Significant differences in management strategy exist among physicians; (3) Medical literature and professional guidelines are strong influences for these decisions; (4) A lead failure registry could help identify reasons for such differences and help guide management.