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Fluoroscopic and Electrical Assessment of a Series of Defibrillation Leads: Prevalence of Externalized Conductors
Author(s) -
KODOTH VIVEK N.,
HODKINSON EMILY C.,
NOAD REBECCA L.,
ASHFIELD KYLE P.,
CROMIE NICHOLAS A.,
McENEANEY DAVID J.,
WILSON CAROL M.,
ROBERTS MICHAEL J. D.
Publication year - 2012
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/pace.12010
Subject(s) - medicine , fluoroscopy , lead (geology) , defibrillation , electrical conductor , cohort , prospective cohort study , surgery , geomorphology , geology , physics , quantum mechanics
Insulation defects with externalized conductors have been reported in the St. Jude Riata ® family of defibrillation leads (St. Jude Medical, Sylmar, CA, USA). The objective of the Northern Ireland Riata ® lead screening program was to identify insulation defects and externalized conductors by systematic fluoroscopic and electrical assessment in a prospectively defined cohort of patients. We sought to estimate the prevalence, identify risk factors, and determine the natural history of this abnormality.Methods: All patients with a Riata ® lead under follow‐up at the Royal Victoria Hospital were invited for fluoroscopic imaging and implantable cardioverter‐defibrillator lead parameter checks. Fluoroscopic images were read independently by two cardiologists and the presence of externalized conductors was classified as positive, negative, or borderline.Results:One hundred and sixty‐five of 212 patients with a Riata lead were evaluated by fluoroscopy and lead parameter measurements. The mean duration after implantation was 3.98+/−1.43 years. After screening 25 (15%) patients were classified as positive, 137 (83%) negative, and three (1.8%) borderline. Time since implantation (P = 0.001), presence of a single coil lead (P = 0.042), and patient age (P = 0.034) were significantly associated with externalized conductors. The observed rate of externalized conductors was 26.9% for 8‐French and 4.7% for 7‐French leads. No leads that were identified prospectively with externalized conductors had electrical abnormalities. Seven of 25 (28%) patients had a defective lead extracted by the end of this screening period.Conclusion:A significant proportion (15%) of patients with a Riata lead had an insulation breach 4 years after implantation. High‐resolution fluoroscopic imaging in at least two orthogonal views is required to identify this abnormality. (PACE 2012;35:1498–1504)