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Baroni M, Gigli L, Posca F, Carbonaro M, Leidi F, Fortuna M, Ciampi CM, Proietti R. Direct anchoring technique for pacing and defibrillation leads inserted through cephalic vein: insight for a single high-volume center. Minerva Cardiol Angiol 2023; 71:342-348. [PMID: 36305778 DOI: 10.23736/s2724-5683.22.06147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Direct anchoring of PM and ICD leads over cephalic vein body is officially discouraged by manufactures due to a supposed risk of conductor fracture or insulation failure, however careful tightening of anchoring knots can probably prevent lead damage. Direct anchoring (DA) technique is routinely used in our center for all leads inserted by cephalic vein while standard anchoring sleeves are used to secure subclavian leads only. Aim of the study is to assess short- and long-term safety of cephalic direct anchoring technique. METHODS All patients undergoing PM and ICD implantation in our center from November 2014 to March 2016 were consecutively enrolled. Primary endpoints were acute lead fracture, lead dislodgement and chronic lead failure. Secondary endpoint was a composite of short-term surgical complications (pocket hematoma, pneumothorax, and pericardial effusion) plus device infections. Subclavian leads secured with sleeve anchoring (SA) were used as control. RESULTS A total of 550 leads were implanted in 310 consecutive patients. DA involved 323 leads (59%) while SA was used for 227 (41%). Median follow-up was 50 months (IQR 24-62 months). 17 lead malfunctions (3.1%) were observed during follow-up. No difference was observed between groups (10 DA vs. 7 SP, P=ns). Survival analysis found no difference between groups. Secondary endpoints were not statistically different between groups (5 vs. 1, P=0.08). CONCLUSIONS Direct anchoring technique of PM and ICD leads is a safe technique and does not increase lead malfunction risk.
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Affiliation(s)
- Matteo Baroni
- De' Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Lorenzo Gigli
- De' Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Posca
- Cardiology Department, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marco Carbonaro
- De' Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Filippo Leidi
- De' Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Fortuna
- De' Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudio M Ciampi
- De' Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Liverpool Heart and Chest Hospital, Liverpool, UK
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Caughron H, Bowman H, Raitt MH, Whooley MA, Tarasovsky G, Shen H, Matheny ME, Selzman KA, Wang L, Major J, Odobasic H, Dhruva SS. Cardiovascular implantable electronic device lead safety: Harnessing real-world remote monitoring data for medical device evaluation. Heart Rhythm 2023; 20:512-519. [PMID: 36586706 DOI: 10.1016/j.hrthm.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers, and attrition; studies relying on administrative codes, which lack specificity; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead. OBJECTIVE The purpose of this study was to determine whether adjudicated remote monitoring (RM) data can address these limitations and augment lead safety evaluation. METHODS Among 48,191 actively monitored patients with a cardiovascular implantable electronic device, we identified RM transmissions signifying incident lead abnormalities and, separately, identified all leads abandoned or extracted between April 1, 2019, and April 1, 2021. We queried electronic health record and Medicare fee-for-service claims data to determine whether patients had administrative codes for lead failure. We verified lead failure through manual electronic health record review. RESULTS Of the 48,191 patients, 1170 (2.4%) had incident lead abnormalities detected by RM. Of these, 409 patients had administrative codes for lead failure, and 233 of these 409 patients (57.0%) had structural lead failure verified through chart review. Of the 761 patients without administrative codes, 167 (21.9%) had structural lead failure verified through chart review. Thus, 400 patients with RM transmissions suggestive of lead abnormalities (34.2%) had structural lead failure. In addition, 200 patients without preceding abnormal RM transmissions had leads abandoned or extracted for structural failure, making the total lead failure cohort 600 patients (66.7% with RM abnormalities, 33.3% without). Patients with isolated right atrial or left ventricular lead failure were less likely to have lead replacement and administrative codes reflective of lead failure. CONCLUSION RM may strengthen real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.
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Affiliation(s)
- Hope Caughron
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Hilary Bowman
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Merritt H Raitt
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon; Portland Veterans Affairs Health Care System, Portland, Oregon
| | - Mary A Whooley
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Gary Tarasovsky
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Hui Shen
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Service, Tennessee Valley Veterans Affairs Health Care System, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kimberly A Selzman
- Division of Cardiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Salt Lake City Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Li Wang
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Jacqueline Major
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Hetal Odobasic
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.
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Giacopelli D, Azzolina D, Comoretto RI, Quartieri F, Rovaris G, Schillaci V, Gargaro A, Gregori D. Implantable cardioverter defibrillator lead performance: A systematic review and individual patient data Meta-analysis. Int J Cardiol 2023; 373:57-63. [PMID: 36460209 DOI: 10.1016/j.ijcard.2022.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reliable post-approval surveillance of implantable cardioverter-defibrillator (ICD) lead performance remains a challenge. In the past, two ICD leads were recalled due to a high frequency of failures. In this meta-analysis, we sought to provide a combined estimate of failure-free rate for ICD leads by reconstructing individual patient data from published Kaplan-Meier (KM) curves and to investigate whether estimates could be influenced by the characteristics of the study. METHODS Observational studies assessing failure-free estimates of transvenous ICD leads with KM method, were identified through a systematic search up to November 2021. RESULTS Forty-four studies were eligible that included 41,870 (63.1%) non-recalled leads and 24,493 (36.9%) recalled leads. The 8-year cumulative failure-free rate was 94.1% (CI, 93.6% - 94.6%) for contemporary non-recalled leads and 81.2% (80.3% - 82.0%) for recalled leads (hazard ratio [HR], 3.15 [2.85-3.47], p < 0.001). Failure-free rate was lower in single-center studies in both the non-recalled (HR, 0.28 [0.15-0.51], p < 0.001) and recalled (HR, 0.54 [0.33-0.88], p = 0.014) group compared with multicenter studies. Similarly, estimates were significantly lower in small (i.e. extracted KM curve with <312 leads) versus large studies (HR non-recalled group, 0.54 [CI, 0.33-0.89], p = 0.015; HR recalled group, 0.62 [CI, 0.43-0.89], p = 0.009). CONCLUSIONS In this meta-analysis including >66,000 leads, we provide pooled survival curves that may play a role in generating evidence-based standards for assessing clinically acceptable failure rates for ICD leads. Lead performance was underestimated with single-center and small-sized studies; multicenter studies remain the main tool to reliably conduct post-market surveillance of ICD leads.
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Affiliation(s)
- Daniele Giacopelli
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy; Clinical Unit, Biotronik Italia, Milan, Italy.
| | - Danila Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | | | - Fabio Quartieri
- Department of Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
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Seiler T, Grebmer C, Hilfiker G, Kobza R, Berte B. Early Experience with the Biotronik Protego ICD Lead. J Clin Med 2022; 11:jcm11237070. [PMID: 36498645 PMCID: PMC9736976 DOI: 10.3390/jcm11237070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: In the last decade, newer generation ICD leads have been developed based on mechanistic insides of priorly failing leads. The aim of our study was to assess the long-term performance and mechanisms of failure of the 2013-introduced Biotronik Protego ICD lead in a real-world population. Methods: All patients, who underwent implantation of a Protego ICD lead at the Heart Centre Lucerne (Lucerne, Switzerland) between November 2013 and March 2017, were followed up with semi-annual device-controls. The primary endpoint was defined as lead failure, secondary endpoints compromised all-cause death, (in)appropriate shocks and the need for reintervention. Results: A total of 64 patients (mean age 66.7 ± 8.7 years, 30% female) underwent implantation of a Protego ICD lead: 78% for primary prevention, 53% had underlying ischemic heart disease, and 40.6% had a dilated cardiomyopathy (DCM). Mean left ventricular ejection fraction (LVEF) was 32.6 ± 10.5%. A total of 24 patients were treated with cardiac resynchronization therapy (CRT), and their baseline LVEF improved from 27.8 ± 7.3% before to 39.8 ± 12.5 after implantation (p < 0.001). Mean time to follow-up was 5.5 ± 0.9 years. Overall, 14 patients (26.6%) suffered from at least one episode of sustained ventricular tachycardia; in total 10 patients (15.6%) died. Two patients experienced lead failure due to lead fracture after 5.5 and 5.7 years, which was clinically apparent by an abrupt rise in lead impedance (>2000 Ω) and by repetitive inappropriate shocks, respectively. Conclusions: In this retrospective observational study, the calculated annual lead failure rate of the Biotronik Protego ICD lead was 0.59% per patient—thus, the durability and long-term performance seem to be promising.
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Alasti M, Machado C, Mirzaee S, Healy S, Bittinger L, Adam D, Kotschet E, Krafchek J, Alison J. Long-term longevity and clinical outcomes of Linox S/SD implantable cardioverter-defibrillator leads: a single-center experience. J Interv Card Electrophysiol 2020; 61:115-121. [PMID: 32488749 DOI: 10.1007/s10840-020-00787-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Since the introduction of the Biotronik Linox S/SD leads in 2006, there have been multiple reports of premature lead failure. The purpose of this study was to investigate the longevity of the Linox S/SD leads and to identify the possible predictors of lead failure in a single tertiary implant center. METHODS We retrospectively reviewed patients who underwent implantation of Linox S/SD leads or Sorin Vigila 1CR/2CR leads (the same Linox S/SD leads marketed by Sorin) at our center. The cumulative lead survival was estimated using the Kaplan-Meier curve, and variables associated with lead failure were assessed by Cox proportional hazard model. RESULTS A total of 187 patients (154 (82%) male) underwent Linox S/SD or Vigila 1CR/2CR implantation between 2007 and 2013. During follow-up with a median time of 75 months, nine lead failures were identified (4.8%). The mean and median times from lead implantation to lead failure were 70.7 ± 21 months and 64 (45-111) months, respectively. The cumulative survival probability for the Linox S/SD at 5 years was 97.1% and at 12 years was 90.3%. Non-physiological high-rate sensing was the most common type of lead failure in patients. In two-thirds of these patients, this led to inappropriate shock. We did not find any significant relationships between patients' clinical and procedural characteristics and lead failure. CONCLUSIONS At our center, the 5-year lead survival of the Linox S/SD has been better than reports from other centers. The majority of lead failures presented as non-physiological high-rate sensing with subsequent inappropriate therapy.
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Affiliation(s)
- Mohammad Alasti
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia.
| | - Colin Machado
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Sam Mirzaee
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Stewart Healy
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Logan Bittinger
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - David Adam
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Emily Kotschet
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Jack Krafchek
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Jeffrey Alison
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
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Marai I, Milman A, Nof E, Gurevitz O, Barlev D, Lipchenca I, Bachar S, Glikson M, Beinart R. Performance of the Linox implantable cardioverter defibrillator leads: A single‐center experience. Pacing Clin Electrophysiol 2019; 42:1524-1528. [DOI: 10.1111/pace.13816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/02/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ibrahim Marai
- Division of Pacing and Electrophysiology, Cardiovascular Center, Baruch Padeh Poriya Medical Center, and Azrieli Faculty of MedicineBar‐Ilan University Ramat Gan Israel
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Anat Milman
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Eyal Nof
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Osnat Gurevitz
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - David Barlev
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Igor Lipchenca
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Sharona Bachar
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Michael Glikson
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
| | - Roy Beinart
- Davidai Arrhythmia Center, Levaiev Heart Institute, Sheba Medical Center, Tel Hashomer, and Sackler School of medicineTel Aviv University Tel Aviv Israel
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