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Zeitler EP, Pokorney SD, Zhou K, Lewis RK, Greenfield RA, Daubert JP, Matchar DB, Piccini JP. Cable externalization and electrical failure of the Riata family of implantable cardioverter-defibrillator leads: A systematic review and meta-analysis. Heart Rhythm 2015; 12:1233-40. [PMID: 25998139 DOI: 10.1016/j.hrthm.2015.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Riata class of defibrillator leads were placed under US Food and Drug Association (FDA) advisory as of November 2011 because of high rates of cable externalization (CE) and electrical failure (EF). The overall rates of these complications remain unknown. OBJECTIVE The purpose of this study was to systematically search the literature for rates of Riata lead failure and to perform a meta-analysis to estimate failure rates. METHODS We conducted a meta-analysis of observational studies examining the rates of EF, CE, and the interaction of the two. We identified 23 English language manuscripts addressing 1 or more of these questions. RESULTS Across 23 studies, the overall CE rate was 23.1% (95% confidence interval [CI] 19.0%-27.6%). The overall EF rate was 6.3% (95% CI 4.7%-8.2%). The presence of CE was associated with a more than 6-fold increase in the rate of EF compared to no CE (17.3% [95% CI 11.2%-25.9%] vs 2.7% [95% CI 1.4%-5.2%], respectively). The rate of CE was 3-fold higher for 8Fr leads compared to 7Fr leads, but rates of EF were similar (4.6%; 95% CI 3.2-6.6] and 3.9%; 95% CI 2.4-6.1], respectively). Rates of both CE and EF were higher in dual coil vs single coil leads, but confidence intervals overlapped. CONCLUSION In clinical practice, rates of CE in Riata leads are substantial. While CE is associated with a significant increase in the risk of EF, the incidence of EF without externalization is not trivial.
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Affiliation(s)
- Emily P Zeitler
- Duke Clinical Research Institute, Duke University Medical System, Durham, North Carolina
| | - Sean D Pokorney
- Duke Clinical Research Institute, Duke University Medical System, Durham, North Carolina
| | - Ke Zhou
- Duke-NUS Graduate Medical School, Singapore
| | - Robert K Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ruth Ann Greenfield
- Duke Clinical Research Institute, Duke University Medical System, Durham, North Carolina
| | - James P Daubert
- Duke Clinical Research Institute, Duke University Medical System, Durham, North Carolina
| | - David B Matchar
- Duke-NUS Graduate Medical School, Singapore; Duke University Medical System, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University Medical System, Durham, North Carolina.
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Hussain S, Moorman L, Moorman JR, DiMarco JP, Malhotra R, Darby A, Bilchick K, Mangrum JM, Ferguson JD, Mason PK. Cost of a recall of a single-center experience managing the Riata defibrillator lead. Am J Cardiol 2015; 115:206-8. [PMID: 25479754 DOI: 10.1016/j.amjcard.2014.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 11/26/2022]
Abstract
Riata and Riata ST defibrillator leads (St. Jude Medical, Sylmar, California) were recalled in 2011 due to increased risk of insulation failure leading to externalized cables. Fluoroscopic screening can identify insulation failure, although the relation between mechanical failure and electrical failure is unclear. At the time of the recall, the University of Virginia developed a screening program, including fluoroscopic evaluation, education sessions, device interrogation, and remote monitoring for patients with this defibrillator lead. The aim of this study was to review the outcomes of the screening program, including costs, which were absorbed by our institution. Costs were calculated using Medicare reimbursement estimates. Forty-eight patients participated in the screening program. At initial screening, 31% were found to have evidence of insulation failure but electrical function was normal in all leads. The cost of this program was $35,358.72. The cost per diagnosis of mechanical lead failure was $2,357.25. During 2 years of follow-up, 1 patient experienced Riata lead electrical failure without fluoroscopic evidence of insulation failure. Patients were more likely to have a lead revision if there was evidence of insulation failure. Lead revisions occurred at the time of generator change in 88% of patients with insulation failure but in only 14% of patients with a fluoroscopically normal lead (p = 0.04). The cost of recall-related defibrillator lead revisions was $81,704.55. In conclusion, our Riata screening program added expense without clear benefit to patients. In fact, patients may have been put at more risk by undergoing defibrillator lead revisions based solely on the results of the fluoroscopic screening.
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Affiliation(s)
- Sarah Hussain
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Liza Moorman
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - J Randall Moorman
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John P DiMarco
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Rohit Malhotra
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Darby
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Kenneth Bilchick
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - J Michael Mangrum
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John D Ferguson
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Pamela K Mason
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
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POKORNEY SEAND, ZHOU KE, MATCHAR DAVIDB, LOVE SEAN, ZEITLER EMILYP, LEWIS ROBERT, PICCINI JONATHANP. Optimal Management of Riata Leads with No Known Electrical Abnormalities or Externalization: A Decision Analysis. J Cardiovasc Electrophysiol 2014; 26:184-91. [DOI: 10.1111/jce.12563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/07/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- SEAN D. POKORNEY
- Division of Cardiology; Duke University Medical Center; Durham North Carolina USA
| | - KE ZHOU
- Department of Health Services and Systems Research; Duke-National University of Singapore Graduate Medical School; Singapore
| | - DAVID B. MATCHAR
- Division of Cardiology; Duke University Medical Center; Durham North Carolina USA
- Department of Health Services and Systems Research; Duke-National University of Singapore Graduate Medical School; Singapore
| | - SEAN LOVE
- Department of Health Services and Systems Research; Duke-National University of Singapore Graduate Medical School; Singapore
| | - EMILY P. ZEITLER
- Division of Cardiology; Duke University Medical Center; Durham North Carolina USA
| | - ROBERT LEWIS
- Division of Cardiology; Duke University Medical Center; Durham North Carolina USA
| | - JONATHAN P. PICCINI
- Division of Cardiology; Duke University Medical Center; Durham North Carolina USA
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McKEAG NICHOLASA, HODKINSON EMILYC, NOAD REBECCAL, KODOTH VIVEKN, ASHFIELD KYLE, WILSON CAROLM, McENEANEY DAVIDJ, ROBERTS MICHAELJ. Fluoroscopic and Electrical Assessment of Implantable Cardioverter Defibrillator Leads: A Prospective Observational Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1538-43. [DOI: 10.1111/pace.12473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- NICHOLAS A. McKEAG
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
| | - EMILY C. HODKINSON
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
| | - REBECCA L. NOAD
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
| | - VIVEK N. KODOTH
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
| | - KYLE ASHFIELD
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
| | - CAROL M. WILSON
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
| | - DAVID J. McENEANEY
- Craigavon Cardiac Centre, Craigavon Hospital, Southern Health and Social Care Trust; Portadown UK
| | - MICHAEL J.D. ROBERTS
- Cardiology Department; Royal Victoria Hospital; Belfast Health and Social Care Trust; Belfast UK
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Demirel F, Adiyaman A, Delnoy PPHM, Smit JJJ, Ramdat Misier AR, Elvan A. Mechanical and electrical dysfunction of Riata implantable cardioverter-defibrillator leads. Europace 2014; 16:1787-94. [PMID: 24843049 DOI: 10.1093/europace/euu079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM Riata implantable cardioverter-defibrillator leads are prone to failure by conductor externalization and/or electrical dysfunction. The objectives of this study were to determine the predictors of the Riata lead failure, to assess the association of conductor externalization and electrical lead failure, and to analyse the rates of lead failure over time. METHODS AND RESULTS Of 273 implanted Riata leads in our centre, 197 were investigated according to the Riata recall protocol, including electrical measurements by device interrogation and annually fluoroscopy. During a mean follow-up period of 5.6 ± 1.4 years, Riata lead failure was 18.8% (37 of 197) for externalization and 17.3% (34 of 197) for electrical lead failure. Electrical lead failure was correlated with time after implant. Externalization and electrical dysfunction co-existed in only 6 of 197 (3%) patients and were not related (Phi's coefficient -0.013, P = 0.85). During the second annual screening, 145 (73.6%) patients underwent fluoroscopy and 9 patients had novel externalizations resulting in an incidence of 6.72%/patient/year which was higher than expected based on cross-sectional analysis. Besides, there was a significant increase in the extent of externalization (17.65 ± 11.14 mm vs. 21.77 ± 11.95 mm, P = 0.001). In multivariate Cox regression analysis, non-ischaemic cardiomyopathy and impaired LVEF were independent predictors of externalization, and 7 Fr lead was a predictor of electrical lead failure. CONCLUSION Riata leads show progressive and high externalization rates without correlation between externalization and electrical lead failure. Non-ischaemic cardiomyopathy and impaired LVEF are independent predictors of structural lead failure in cross-sectional analysis, whereas 7 Fr lead is a predictor of electrical lead failure.
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Affiliation(s)
- Fatma Demirel
- Department of Cardiology, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Peter Paul H M Delnoy
- Department of Cardiology, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Anand R Ramdat Misier
- Department of Cardiology, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Klinieken, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Forleo GB, Di Biase L, Panattoni G, Politano A, Magliano G, Santini L, Natale A, Romeo F. Systematic fluoroscopic and electrical assessment of implantable cardioverter-defibrillator patients implanted with silicone-polyurethane copolymer (Optim ) coated leads. Europace 2013; 16:265-70. [DOI: 10.1093/europace/eut236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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LAU ERNESTW. Differential Lead Component Pulling as a Possible Mechanism of Inside-Out Abrasion and Conductor Cable Externalization. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1072-89. [DOI: 10.1111/pace.12185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/01/2013] [Accepted: 04/23/2013] [Indexed: 02/06/2023]
Affiliation(s)
- ERNEST W. LAU
- Department of Cardiology; Royal Victoria Hospital; Belfast UK
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