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Mar PL, Tsai C, Golemi L, Bedi R, Khan A, Kabra R, Atkins D, Bhakta D, Lakkireddy D, Gopinathannair R. Poorer outcomes associated with more invasive lead management strategies for Abbott Riata ® leads: a large, multicenter experience. J Interv Card Electrophysiol 2024; 67:1127-1132. [PMID: 37882994 DOI: 10.1007/s10840-023-01673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Over 100,000 Abbott Riata® were implanted in the United States before they were recalled in 2010. There are still a significant number of Abbott Riata® leads in use, and it is unclear how these leads should be managed at the time of generator change or lead malfunction. Although data comparing both Sprint Fidelis® and Abbott Riata® leads in this setting is available, there are no multicenter comparative studies of outcomes for various lead management strategies, including lead extraction (LE), lead abandonment/revision (LA), and generator change (GC) only at the time of device at elective replacement interval (ERI) for Abbott Riata® leads. METHODS A retrospective, multicenter study was undertaken to compare short-term outcomes (major complications-MC, death, extended or re-hospitalizations within 60 days-RH, lead malfunction-LM) and total outcomes (short-term outcomes & lead malfunction during follow-up) of patients with Riata® leads undergoing LE, LA, or GC. RESULTS 152 patients (65 ± 13 years, 68% male) were followed for a mean 33 ± 30 months following intervention. Out of 166 procedures, 13 patients underwent LE, 16 patients underwent LA, and 137 patients underwent GC. There was 1 major complication in each group, yielding an event rate of 7.7% for LE, 6.3% for LA, and 0.7% for GC cohorts. There were significantly more short-term and total adverse outcomes in the group of patients getting LE and LA versus GC only (38.5% & 31.3% vs 7.3%, P < 0.001). Total Riata® lead dwell time follow-up was 17,067 months. A total of 3 Riata® lead malfunctions were noted during long-term follow-up. Inappropriate shocks were similar between LE 7.7% (1/13), LA 6.3% (1/16). and GC 11.0% (4/136); P = 0.57. CONCLUSIONS There were more short-term and total adverse outcomes in more invasive management strategies (LE and LA) versus GC alone. The failure rate of Riata® leads was substantially lower compared to previous reports. Therefore, we recommend only performing battery exchange when a device with an active Riata® lead is at ERI, unless there is malfunction of the Riata® lead noted on testing.
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Affiliation(s)
- Philip L Mar
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Christina Tsai
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Lolita Golemi
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Rohil Bedi
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Ali Khan
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Rajesh Kabra
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA
| | - Donita Atkins
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA
| | - Deepak Bhakta
- Division of Cardiology, Indiana University, Indianapolis, IN, USA
| | - Dhanunjaya Lakkireddy
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA
| | - Rakesh Gopinathannair
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA.
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Hayashi K, Callahan T, Wilkoff BL. Failed defibrillation with unexpected battery depletion by cable externalization of dual-coil defibrillator lead. HeartRhythm Case Rep 2024; 10:476-478. [PMID: 39129738 PMCID: PMC11312030 DOI: 10.1016/j.hrcr.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Affiliation(s)
- Katsuhide Hayashi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L. Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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Ibrahim R, Al-Gibbawi M, Mekary W, Bhatia NK, Kiani S, Westerman SB, Shah AD, Lloyd MS, Leal M, De Lurgio DB, Patel AM, Tompkins C, Leon AR, Merchant FM, El-Chami MF. Long-term performance of single-connector (DF4) implantable defibrillator leads. Europace 2023; 25:euad347. [PMID: 38000900 PMCID: PMC10751803 DOI: 10.1093/europace/euad347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
AIMS Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their long-term performance are derived predominantly from manufacturer product performance reports. METHODS AND RESULTS We reviewed medical records in 5289 patients with DF4 leads between 2011 and 2023 to determine the frequency of lead-related abnormalities. We defined malfunction as any single or combination of electrical abnormalities requiring revision including a sudden increase (≥2×) in stimulation threshold, a discrete jump in high-voltage impedance, or sensing of non-physiologic intervals or noise. We documented time to failure, predictors of failure, and management strategies. Mean follow-up after implant was 4.15 ± 3.6 years (median = 3.63), with 37% of leads followed for >5 years. A total of 80 (1.5%) leads demonstrated electrical abnormalities requiring revision with an average time to failure of 4 ± 2.8 years (median = 3.5). Of the leads that malfunctioned, 62/80 (78%) were extracted and replaced with a new lead and in the other 18 cases, malfunctioned DF4 leads were abandoned, and a new lead implanted. In multivariable models, younger age at implant (OR 1.03 per year; P < 0.001) and the presence of Abbott/St. Jude leads increased the risk of malfunction. CONCLUSION DF4 defibrillator leads demonstrate excellent longevity with >98.3% of leads followed for at least 5 years still functioning normally. Younger age at implant and lead manufacturer are associated with an increased risk of DF4 lead malfunction. The differences in lead survival between manufacturers require further investigation.
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Affiliation(s)
- Rand Ibrahim
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Mounir Al-Gibbawi
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Wissam Mekary
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Neal Kumar Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Soroosh Kiani
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Stacy B Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Anand D Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Michael S Lloyd
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Miguel Leal
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - David B De Lurgio
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Anshul M Patel
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Christine Tompkins
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Angel R Leon
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, 30308 Atlanta, GA, USA
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4
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Lloyd MS, Brisben AJ, Reddy VY, Blomström-Lundqvist C, Boersma LV, Bongiorni MG, Burke MC, Cantillon DJ, Doshi R, Friedman PA, Gras D, Kutalek SP, Neuzil P, Roberts PR, Wright DJ, Appl U, West J, Carter N, Stein KM, Mont L, Knops RE. Design and rationale of the MODULAR ATP global clinical trial: A novel intercommunicative leadless pacing system and the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm O2 2023; 4:448-456. [PMID: 37520021 PMCID: PMC10373150 DOI: 10.1016/j.hroo.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) has demonstrated safety and efficacy for the treatment of malignant ventricular arrhythmias. However, a limitation of the S-ICD lies in the inability to either pace-terminate ventricular tachycardia or provide prolonged bradycardia pacing support. Objective The rationale and design of a prospective, single-arm, multinational trial of an intercommunicative leadless pacing system integrated with the S-ICD will be presented. Methods A technical description of the modular cardiac rhythm management (mCRM) system (EMPOWER leadless pacemaker and EMBLEM S-ICD) and the implantation procedure is provided. MODULAR ATP (Effectiveness of the EMPOWER™ Modular Pacing System and EMBLEM™ Subcutaneous ICD to Communicate Antitachycardia Pacing) is a multicenter, international trial enrolling up to 300 patients at risk of sudden cardiac death at up to 60 centers trial design. The safety endpoint of freedom from major complications related to the mCRM system or implantation procedure at 6 months and 2 years are significantly higher than 86% and 81%, respectively, and all-cause survival is significantly >85% at 2 years. Results Efficacy endpoints are that at 6 months mCRM communication success is significantly higher than 88% and the percentage of subjects with low and stable thresholds is significantly higher than 80%. Substudies to evaluate rate-responsive features and performance of the pacing module are also described. Conclusion The MODULAR ATP global clinical trial will prospectively test the safety and efficacy of the first intercommunicating leadless pacing system with the S-ICD. This trial will allow for robust validation of device-device communication, pacing performance, rate responsiveness, and system safety.
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Affiliation(s)
| | | | - Vivek Y. Reddy
- Icahn School of Medicine, Mount Sinai, New York, New York
| | - Carina Blomström-Lundqvist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, Cardiology - Arrhythmia, Uppsala University, Uppsala, Sweden
| | - Lucas V.A. Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Rahul Doshi
- Heart and Vascular Health, HonorHealth Research Institute, Scottsdale, Arizona
- College of Medicine, University of Arizona, Phoenix, Arizona
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Gras
- Departement de Cardiologie, Hôpital Privé du Confluent, Nantes, France
| | - Steven P. Kutalek
- Department of Cardiology, Saint Mary Medical Center, Langhorne, Pennsylvania
- Cardiac Electrophysiology, Drexel University, Philadelphia, Pennsylvania
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Paul R. Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - David J. Wright
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ursula Appl
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Julie West
- Boston Scientific Corporation, St. Paul, Minnesota
| | | | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Reinoud E. Knops
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Mehdinejadshani M, Fallah H, Kamali F, Alizadeh-Diz A, Eslami M, Golabchi A, Taherpour M, Shahabi J, Mollazadeh R, Madadi S, Azhari A, Sodagar A, Eftekharzadeh M, Oraii S, Fazelifar A, Kazemisaeed A, Ghorbanisharif A, Dalili M, Khorgami M, Heidari-Bakavoli A, Jorat M, Nikoo H, Kheirkhah J, Saravi M, Khodaparast M, Mirzaali M, Emkanjoo Z, Mirmasoumi M, Sadeghian S, Mokhtari M, Hedayati-Goudarzi M, Haghjoo M. Clinical outcomes of subcutaneous implantable cardiac defibrillator implantation - Iran SICD registry. Pacing Clin Electrophysiol 2023; 46:273-278. [PMID: 36751953 DOI: 10.1111/pace.14668] [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: 12/11/2022] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The subcutaneous implantable-defibrillator (S-ICD) is a relatively new alternative to the transvenous ICD system to minimize intravascular lead-related complications. This paper presents outcome of SICD implantation in patients enrolled in Iran S-ICD registry. METHODS Between October 2015 and June 2022, this prospective multicenter national registry included 223 patients with a standard indication for an ICD, who neither required bradycardia pacing nor needed cardiac resynchronization to evaluate the early post-implant complications and long-term follow-up results of the S-ICD system. RESULTS The mean age of the patients was 45 ± 17 years. The majority (79.4%) were male. Ischemic cardiomyopathy (39.5%) was the most common underlying disorder among patients selected for S-ICD implant. Most study patients (68.6%) had ICD for primary prevention of sudden cardiac death. Seven patients (3.1%) were found to have suboptimal lead positions. Six patients (2.7%) developed a pocket hematoma; all were managed medically. During a mean follow-up of 2 years, the appropriate therapy was recorded in 13% of the patients and inappropriate ICD intervention mainly due to supraventricular tachycardia in 8.9%. Pocket infection was observed in four patients (1.8%) and five patients (2.2%) died mainly due to heart failure. CONCLUSION S-ICDs were effective at detecting and treating both induced and spontaneous ventricular arrhythmias. Major clinical complications were rare.
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Affiliation(s)
- Mahdiye Mehdinejadshani
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Fallah
- Department of Cardiology, Faculty of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farzad Kamali
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadeh-Diz
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Eslami
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Allahyar Golabchi
- The Advocate Center for Clinical Research, Ayatollah Yasrebi Hospital, Kashan, Iran
| | | | - Javad Shahabi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Mollazadeh
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Madadi
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Azhari
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - Amirfarjam Fazelifar
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemisaeed
- Cardiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Dalili
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadrafie Khorgami
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireaza Heidari-Bakavoli
- Department of Cardiovascular Disease, Faculty of Medcine, Mashhad University of Medical Sciences, Mashahd, Iran
| | | | - Hossein Nikoo
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Kheirkhah
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrdad Saravi
- Department of Cardiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Morteza Khodaparast
- Zavareh Atherosclerosis Research Center, Baqyitallah University of Medical Sciences, Tehran, Iran
| | - Mansour Mirzaali
- Shafa Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Emkanjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Meisam Mokhtari
- Cardiac Electrophysiology Department, Shahid Chamran Cardiovascular Medical and Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Majid Haghjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Uppal A, Kathuria S, Shah B, Trehan V. Riata lead failure manifests as electrical storm with lead parameters showing unique postural variations: a case report. Eur Heart J Case Rep 2021; 5:ytab491. [PMID: 34909577 PMCID: PMC8665680 DOI: 10.1093/ehjcr/ytab491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/07/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Background Riata implantable cardioverter-defibrillator (ICD) leads are prone to a unique type of mechanical lead failure causing conductor externalization (CE) which may be complicated by a delayed-onset electrical lead failure (ELF). Case summary A 60-year-old male with symptomatic, severe ischaemic cardiomyopathy, and atrial fibrillation following a prior anterior wall myocardial infarction received a dual-chamber ICD with 7F-RiataST ventricular lead as a primary prevention strategy against sudden cardiac death in 2008. In 2017, a pulse generator replacement was performed for elective replacement indicator status. At that time, CE was noted in the ventricular lead but the electrical lead parameters were normal, hence lead replacement was decided against and the patient was closely followed up thereafter. Four years later, the patient presented with multiple ICD shocks within 48 h. Implantable cardioverter-defibrillator interrogation showed noise on the ventricular electrogram (EGM) channel that was detected as ventricular fibrillation (VF) episodes, triggering inappropriate ICD therapy (five ICD detected VF events within 24 h triggering three antitachycardia pacing therapies and one shock). Lead impedance and R-wave amplitude were within normal range in supine position but dramatically worsened in sitting posture. A new ventricular lead was implanted and the old lead abandoned. The patient has not experienced any device therapy in the follow-up period. Discussion An electrically inert CE of Riata ICD leads needs close follow-up because an ELF may occur even after several years. A careful analysis of EGMs including postural changes in lead parameters can aid in detection and better characterization of underlying electrical dysfunction following CE.
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Affiliation(s)
- Abhimanyu Uppal
- Department of Cardiology, GB Pant Institute of Post Graduate Education and Research, MAMC, JLN Road, New Delhi 110002, India
| | - Sanjeev Kathuria
- Department of Cardiology, GB Pant Institute of Post Graduate Education and Research, MAMC, JLN Road, New Delhi 110002, India
| | - Bhushan Shah
- Department of Cardiology, GB Pant Institute of Post Graduate Education and Research, MAMC, JLN Road, New Delhi 110002, India
| | - Vijay Trehan
- Department of Cardiology, GB Pant Institute of Post Graduate Education and Research, MAMC, JLN Road, New Delhi 110002, India
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Long-term complications in patients implanted with subcutaneous implantable cardioverter-defibrillators: Real-world data from the extended ELISIR experience. Heart Rhythm 2021; 18:2050-2058. [PMID: 34271173 DOI: 10.1016/j.hrthm.2021.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recently, the Food and Drug Administration issued a recall for the subcutaneous implantable cardioverter-defibrillator (S-ICD) because of the possibility of lead ruptures and accelerated battery depletion. OBJECTIVE The aim of this study was to evaluate device-related complications over time in a large real-world multicenter S-ICD cohort. METHODS Patients implanted with an S-ICD from January 2015 to June 2020 were enrolled from a 19-institution European registry (Experience from the Long-term Italian S-ICD registry [ELISIR]; ClinicalTrials.gov identifier NCT0473876). Device-related complication rates over follow-up were collected. Last follow-up of patients was performed after the Boston Scientific recall issue. RESULTS A total of 1254 patients (median age 52.0 [interquartile range 41.0-62.2] years; 973 (77.6%) men; 387 (30.9%) ischemic) was enrolled. Over a follow-up of 23.2 (12.8-37.8) months, complications were observed in 117 patients (9.3%) for a total of 127 device-related complications (23.6% managed conservatively and 76.4% required reintervention). Twenty-seven patients (2.2%) had unanticipated generator replacement after 3.6 (3.3-3.9) years, while 4 (0.3%) had lead rupture. Body mass index (hazard ratio [HR] 1.063 [95% confidence interval 1.028-1.100]; P < .001), chronic kidney disease (HR 1.960 [1.191-3.225]; P = .008), and oral anticoagulation (HR 1.437 [1.010-2.045]; P = .043) were associated with an increase in overall complications, whereas older age (HR 0.980 [0.967-0.994]; P = .007) and procedure performed in high-volume centers (HR 0.463 [0.300-0.715]; P = .001) were protective factors. CONCLUSION The overall complication rate over 23.2 months of follow-up in a multicenter S-ICD cohort was 9.3%. Early unanticipated device battery depletions occurred in 2.2% of patients, while lead fracture was observed in 0.3%, which is in line with the expected rates reported by Boston Scientific.
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8
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Adelstein E, Zhang L, Nazeer H, Loka A, Steckman D. Increased incidence of electrical abnormalities in a pacemaker lead family. J Cardiovasc Electrophysiol 2021; 32:1111-1121. [PMID: 33566384 DOI: 10.1111/jce.14941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Several recent studies have raised concern about noise detections on Tendril pacemaker leads, which may represent insulation failure or algorithm-driven overreporting of physiologic signals. METHODS We identified all pacemaker leads actively followed at Albany Medical Center, of which 1111 leads (262 Abbott Tendril, 576 Medtronic CapSure, 30 Fineline, 195 Ingevity, 48 Dextrus) in 703 patients were included in this observational study. Electrical abnormalities, comprising low-impedance measurements <200 Ω and repeated noise detections, were catalogued, as was initial management and subsequent need for surgical intervention. RESULTS During 54 months median follow-up (interquartile range 24-105), 63 leads (5.7%) demonstrated electrical abnormalities, including low impedances in 21 and noise in 59. Tendril leads manifested abnormalities most frequently (n = 50; 19.1%) compared with CapSure (n = 9; 1.6%), Fineline (n = 0), Ingevity (n = 0), and Dextrus (n = 4; 8.3%) leads. The risk of abnormalities was significantly higher in Tendril leads (HR 9.6, 95% CI 5.2-17.6; p < .001). Low impedances were measured on 19 Tendril leads, a significantly higher risk than on other leads (HR 23.8, 95% CI 5.5-102.1; p < .001). Although observation and reprogramming sensitivity were the initial management strategy for 45 and 7 leads, respectively, 18 ultimately required surgical intervention, including 15 Tendrils. No electrical abnormalities were observed in 12 non-Tendril leads attached to Abbott devices compared with 48 of 252 Tendrils attached to Abbott devices (log-rank p = .035). CONCLUSION Tendril leads demonstrate significantly higher risk of repeated low impedances and noise compared to other manufacturers' models, raising concern that these findings reflect early insulation failure. Increased scrutiny is warranted.
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Affiliation(s)
- Evan Adelstein
- Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Lane Zhang
- Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Haider Nazeer
- Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Alfred Loka
- Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - David Steckman
- Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, New York, USA
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9
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The big short: A lifesaving alternative to a catastrophic lead failure. HeartRhythm Case Rep 2020; 6:831-835. [PMID: 33204616 PMCID: PMC7653473 DOI: 10.1016/j.hrcr.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Mar PL, John A, Kumar S, Barry N, Chen G, Longserre S, Kabra R, Atkins D, Koerber S, Hussein A, Bhakta D, Lakkireddy D, Gopinathannair R. Management and long-term outcomes associated with recalled implantable cardioverter-defibrillator leads: A multicenter experience. Heart Rhythm 2020; 17:1909-1916. [PMID: 32512178 DOI: 10.1016/j.hrthm.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND No comparative study of outcomes in Riata and Sprint Fidelis leads undergoing lead extraction (LE), lead abandonment (LA), and generator change only (GC) has been published. OBJECTIVES Determine outcomes (major complications [MC]; death, extended hospitalization, or rehospitalization within 60 days [RH]; lead malfunction) of LE, LA, and GC for recalled leads. METHODS Retrospective, multicenter, comparative study. RESULTS A total of 298 LE, 85 LA, and 310 GC were performed. In the clinical setting of a lead intervention, there was no difference in a composite of MC, death, RH, lead revision, inappropriate shocks, or device infection between LE and LA groups (15% vs 22%, P = .140). In the clinical setting of a device at elective replacement interval (ERI), there were significantly more acute events at 60 days (MC, death, and RH) in the LE and LA groups at 15.4% (4) and 15.4% (4), and this was significantly (P = .017) higher than the GC group at 5.1% (16). There was no difference (P = 1.000) in the composite of MC, death, RH, lead malfunction, lead revisions, device infections, or inappropriate shocks between LE, LA, and GC groups at 15.4% (4), 15.4% (4), and 17.4% (54), respectively. Following generator change, 14 of 175 Fidelis leads and 3 of 135 Riata leads failed over a total of 12,714 months of follow-up. CONCLUSIONS The failure rate of recalled leads was substantially lower compared to previous reports. It may be prudent to perform generator change only when the device is at ERI, especially when the recalled lead has historical performance that likely outweighs the risks of extraction/abandonment.
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Affiliation(s)
- Philip L Mar
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri
| | - Anub John
- Good Samaritan Hospital, Kearney, Nebraska
| | - Sundeep Kumar
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri
| | - Neil Barry
- Good Samaritan Hospital, Kearney, Nebraska
| | - Guanhua Chen
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Sarah Longserre
- Division of Cardiology, University of Tennessee, Memphis, Tennessee
| | - Rajesh Kabra
- Division of Cardiology, University of Tennessee, Memphis, Tennessee
| | - Donita Atkins
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Scott Koerber
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Ahmed Hussein
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri
| | - Deepak Bhakta
- Division of Cardiology, Indiana University, Indianapolis, Indiana
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11
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Resnic FS, Majithia A, Dhruva SS, Ssemaganda H, Robbins S, Marinac-Dabic D, Hewitt K, Ohno-Machado L, Reynolds MR, Matheny ME. Active Surveillance of the Implantable Cardioverter-Defibrillator Registry for Defibrillator Lead Failures. Circ Cardiovasc Qual Outcomes 2020; 13:e006105. [PMID: 32283971 DOI: 10.1161/circoutcomes.119.006105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several defibrillator leads have been recalled due to early lead failure leading to significant patient harm. Confirming the safety of contemporary defibrillator leads is essential to optimizing treatment for patients receiving implantable cardioverter-defibrillators (ICDs). We therefore sought to assess the comparative long-term safety of the 4 most commonly implanted ICD leads within the National Cardiovascular Data Registry ICD Registry. METHODS AND RESULTS A propensity-matched survival analysis of the ICD Registry was performed evaluating 4 contemporary ICD leads in patients receiving an ICD system for the first time. All patients in the ICD Registry aged ≥18 years who underwent an implant of an ICD between April 1, 2011 and March 31, 2016 were included. Monitoring of safety began with ICD implant and continued up to 5 years. A meaningful difference in ICD failure rate was defined as twice (or more) the lead failure rate observed in the propensity-matched comparator patients. Among the 374 132 patients who received a new ICD implant, no safety alerts were triggered for the primary safety end point of lead failure for any of the high energy leads studied. Estimated rates of freedom from lead failure at 5 years ranged from 97.7% to 98.9% for the 4 high-energy leads of interest. CONCLUSIONS Though limited by incomplete long-term outcomes ascertainment, active surveillance of the ICD Registry suggests that there were no meaningful differences in the rate of ICD high-energy lead survival for the 4 most commonly used high-energy ICD leads.
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Affiliation(s)
- Frederic S Resnic
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Arjun Majithia
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Brigham and Women's Hospital, Boston, MA (A.M.)
| | - Sanket S Dhruva
- UCSF School of Medicine and Section of Cardiology, San Francisco VA Health Care System (S.S.D.)
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Susan Robbins
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD (D.M.-D.)
| | - Kathleen Hewitt
- National Cardiovascular Data Registry, American College of Cardiology, Washington, DC (K.H.)
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla (L.O.-M.)
| | - Matthew R Reynolds
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville (M.E.M.).,Departments of Biomedical Informatics, Biostatistics and Medicine, Vanderbilt University Medical Center, Nashville, TN (M.E.M.)
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12
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Hauser RG, Sengupta J, Schloss EJ, Stanberry LI, Wananu MK, Abdelhadi R. Internal insulation breaches in an implantable cardioverter-defibrillator lead with redundant conductors. Heart Rhythm 2019; 16:1215-1222. [DOI: 10.1016/j.hrthm.2019.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 10/27/2022]
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13
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Kleemann T, Nonnenmacher F, Strauss M, Kouraki K, Werner N, Fendt A, Zahn R. Long‐term performance and lead failure analysis of the Durata defibrillation lead compared to its previous model, the recalled Riata defibrillation lead. J Cardiovasc Electrophysiol 2019; 30:2012-2019. [DOI: 10.1111/jce.14087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/22/2019] [Accepted: 07/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Kleemann
- Klinikum LudwigshafenMedizinische Klinik BLudwigshafen Germany
| | | | - Margit Strauss
- Klinikum LudwigshafenMedizinische Klinik BLudwigshafen Germany
| | | | - Nicolas Werner
- Klinikum LudwigshafenMedizinische Klinik BLudwigshafen Germany
| | - Andràs Fendt
- Klinikum LudwigshafenMedizinische Klinik BLudwigshafen Germany
| | - Ralf Zahn
- Klinikum LudwigshafenMedizinische Klinik BLudwigshafen Germany
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14
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Kleemann T, Strauss M, Kouraki K, Lampropoulou E, Fendt A, Werner N, Zahn R. Contemporary benefit-harm profile over two decades in primary prophylactic ICD-therapy. Clin Cardiol 2019; 42:866-872. [PMID: 31317573 PMCID: PMC6788478 DOI: 10.1002/clc.23234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) was implemented into clinical routine more than 20 years ago. Since then, ICD therapy became standard therapy for primary and secondary prevention of sudden cardiac death in clinical practice. OBJECTIVES Aim of the study was to evaluate the benefit-harm profile of contemporary primary prophylactic ICD therapy. METHODS A total of 1222 consecutive patients of a prospective single-center ICD-registry were analyzed who underwent primary prophylactic ICD implantation between 2000 and 2017. Patients were divided into two groups according to the implantation year: 2010-2017 (group 1, n = 579) and 2000-2009 (group 2, n = 643). RESULTS The rate of estimated appropriate ICD therapy after 8 years was 51% in the 2000s and 42% in the 2010s (P < .001). The complication rate changed slightly from 53% to 47% (P = .005). This decline was mainly driven by the reduction of inappropriate ICD shocks (30% vs 14%, P < .001) whereas the rate of ICD shock lead malfunction and device/ lead infection remained unchanged over time. Nonischemic cardiomyopathy was an independent predictor for ICD complications without benefit of ICD therapy (HR 1.37, 95% CI 1.07-1.77). CONCLUSION The ICD therapy rate for ventricular arrhythmias in patients with primary prophylactic ICD implantation is decreasing over the last two decades. Complication rate remains high due to an unchanged rate of ICD shock malfunctions and device infections. Nonischemic cardiomyopathy is an independent predictor for ICD complications without benefit of ICD therapy in primary prophylactic ICD-therapy.
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Affiliation(s)
- Thomas Kleemann
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
| | - Margit Strauss
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
| | | | | | - Andràs Fendt
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
| | - Nicolas Werner
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
| | - Ralf Zahn
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
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15
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Escudero CA, Mah DY, Miyake CY, Stephenson EA, LaPage MJ, Kubuš P, Cohen M, Atallah J. Riata lead failure in pediatric and congenital heart disease patients. J Cardiovasc Electrophysiol 2019; 30:320-325. [DOI: 10.1111/jce.13812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Carolina A. Escudero
- Department of Pediatrics, Division of Cardiology, University of Alberta and Stollery Children's HospitalEdmonton Canada
| | - Douglas Y. Mah
- Department of Cardiology, Boston Children's HospitalBoston Massachusetts
| | - Christina Y. Miyake
- Department of Pediatrics and Molecular Physiology & Biophysics, Baylor College of MedicineHouston Texas
| | | | - Martin J. LaPage
- Division of Pediatric Cardiology University of MichiganAnn Arbor Michigan
| | - Peter Kubuš
- Children's Heart Centre, Motol University HospitalPrague Czech Republic
| | - Mitchell Cohen
- Division of Cardiology, Phoenix Children's HospitalPhoenix Arizona
| | - Joseph Atallah
- Department of Pediatrics, Division of Cardiology, University of Alberta and Stollery Children's HospitalEdmonton Canada
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16
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Boyle NG, Wilkoff BL. Overview of Lead Management. Card Electrophysiol Clin 2018; 10:549-559. [PMID: 30396571 DOI: 10.1016/j.ccep.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lead management describes a comprehensive approach to cardiac implantable electronic device lead utilization, encompassing lead and device selection, vascular access, implant techniques, handling lead failures and recalls, managing infectious and other complications, and performing device and lead extraction. Device and lead selection should be based on the latest guidelines and the available data to choose the optimal device system for each patient. Lead extraction is a highly specialized procedure and should be carried out by a team of personnel extensively trained in the procedure at centers with cardiac surgical support.
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Affiliation(s)
- Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, USA.
| | - Bruce L Wilkoff
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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17
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Abstract
BACKGROUND The performance of Abbott/St. Jude Medical (Sylmar CA) Tendril pacing leads has not been well characterized. OBJECTIVE We sought to assess the performance of Tendril leads as compared with that of different pacing leads. METHODS We retrospectively identified patients implanted with the following leads: Tendril leads 1888 TC, 2088 TC, and 1688 TC, Medtronic (Fridely, MN) 4076 CapSureFix Novus, and Boston Scientific (Natick, MA) FINELINE II Sterox Pacing EZ leads (models 4469, 4470, and 4471). The primary end point was the incidence of lead malfunction assessed by Kaplan-Meier analysis. RESULTS During the study period, 9782 leads were implanted, including 8512 Tendril leads, 731 Medtronic 4076 CapSureFix Novus leads, and 539 FINELINE II leads. A total of 540 leads (5.5%) malfunctioned during a mean follow-up of 3.6 ± 2.9 years. Lead malfunction manifested predominantly as noise and/or low impedance (95%). Lead malfunction rates were significantly higher at 5 years for Tendril vs non-Tendril leads (7.0% vs 2.1%; P < .001). The highest rate of failure at 5 years was seen in the Tendril 1888 TC leads (9.9%), followed by Tendril 1688 (5.7%) and Tendril 2088 (5.2%) leads. In contrast, malfunction rates were significantly lower for the Medtronic 4076 (2.6%) and FINELINE II (1.7%) leads. During follow-up to 10 years, the incidence of lead malfunction for Optim-insulated Tendril leads (models 1888 TC and 2088 TC) was significantly higher than that for the non-Optim-insulated Tendril 1688 TC lead (24.5% vs 7.1%) (P = .008). CONCLUSION Tendril leads appear to have a higher rate of malfunction than do comparator leads. Optim insulation may partly explain the higher failure rate.
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18
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Segreti L, Giannotti Santoro M, Di Cori A, Zucchelli G, Viani S, De Lucia R, Della Tommasina V, Barletta V, Paperini L, Soldati E, Bongiorni MG. Utility of risk scores to predict adverse events in cardiac lead extraction. Expert Rev Cardiovasc Ther 2018; 16:695-705. [DOI: 10.1080/14779072.2018.1513325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Luca Segreti
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Veronica Della Tommasina
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Luca Paperini
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Ezio Soldati
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
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19
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Lacour P, Parwani A, Huemer M, Attanasio P, Dang PL, Luebcke J, Schleussner L, Blaschke D, Boldt LH, Pieske B, Haverkamp W, Blaschke F. What physicians do in case of a failure of the pace-sense part of a defibrillation lead : Survey in Germany, Austria and Switzerland. Herz 2018; 45:362-368. [PMID: 30054714 DOI: 10.1007/s00059-018-4736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/14/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead. METHODS We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers. RESULTS The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation. CONCLUSION Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.
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Affiliation(s)
- P Lacour
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Parwani
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Huemer
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Attanasio
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P L Dang
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Luebcke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Schleussner
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L-H Boldt
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - B Pieske
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - W Haverkamp
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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20
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Parkash R, Thibault B, Philippon F, Mangat I, Coutu B, Bennett M, Crystal E, Healey J, Verma A, Sandhu R, Cameron D, Ayala-Paredes F, Sterns L, Essebag V, Sturmer M, Nery P, Wells G, Krahn A. Canadian Registry of Implantable Electronic Device Outcomes: Longer-term follow-up of the Riata lead under advisory. Heart Rhythm 2018; 15:524-529. [DOI: 10.1016/j.hrthm.2017.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 11/12/2022]
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21
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Lau EW, Roberts MJ. Inside-out abrasion and contained conductor cable externalization in a defibrillation lead with asymmetric conductor cable lumen distribution. HeartRhythm Case Rep 2018; 4:121-126. [PMID: 29707489 PMCID: PMC5918187 DOI: 10.1016/j.hrcr.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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22
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Sood N, Martin DT, Lampert R, Curtis JP, Parzynski C, Clancy J. Incidence and Predictors of Perioperative Complications With Transvenous Lead Extractions. Circ Arrhythm Electrophysiol 2018; 11:e004768. [DOI: 10.1161/circep.116.004768] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nitesh Sood
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - David T. Martin
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Rachel Lampert
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Jeptha P. Curtis
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Craig Parzynski
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Jude Clancy
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
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23
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Sivan S, Di Prima M, Weaver JD. Effect of Applied Potential on Fatigue Life of Electropolished Nitinol Wires. SHAPE MEMORY AND SUPERELASTICITY : ADVANCES IN SCIENCE AND TECHNOLOGY 2017; 3:238-249. [PMID: 37700745 PMCID: PMC10496021 DOI: 10.1007/s40830-017-0109-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Nitinol is used as a metallic biomaterial in medical devices due to its shape memory and pseudoelastic properties. The clinical performance of nitinol depends on factors which include the surface finish, the local environment, and the mechanical loads to which the device is subjected. Preclinical evaluations of device durability are performed with fatigue tests while electrochemical characterization methods such as ASTM F2129 are employed to evaluate corrosion susceptibility by determining the rest potential and breakdown potential. However, it is well established that the rest potential of a metal surface can vary with the local environment. Very little is known regarding the influence of voltage on fatigue life of nitinol. In this study, we developed a fatigue testing method in which an electrochemical system was integrated with a rotary bend wire fatigue tester. Samples were fatigued at various strain levels at electropotentials anodic and cathodic to the rest potential to determine if it could influence fatigue life. Wires at potentials negative to the rest potential had a significantly higher number of cycles to fracture than wires held at potentials above the breakdown potential. For wires for which no potential was applied, they had fatigue life similar to wires at negative potentials.
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Affiliation(s)
- Shiril Sivan
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Matthew Di Prima
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Jason D. Weaver
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
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Sato T, Soejima K, Yoshino H, Shoda M. Unusual fracture in a Durata lead with shock coil fragmentation and cable externalization. HeartRhythm Case Rep 2017; 3:327-331. [PMID: 28748137 PMCID: PMC5511966 DOI: 10.1016/j.hrcr.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Toshiaki Sato
- Division of Advanced Arrhythmia Management, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Hideaki Yoshino
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Morio Shoda
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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El-Chami MF, Merchant FM, Waheed A, Khattak F, El-Khalil J, Patel A, Sayegh MN, Desai Y, Leon AR, Saba S. Predictors and outcomes of lead extraction requiring a bailout femoral approach: Data from 2 high-volume centers. Heart Rhythm 2017; 14:548-552. [DOI: 10.1016/j.hrthm.2017.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Indexed: 11/25/2022]
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Cable externalization at the proximal portion of the superior vena cava coil in Riata implantable cardioverter defibrillator leads. J Cardiol Cases 2017; 15:3-5. [DOI: 10.1016/j.jccase.2016.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022] Open
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De Maria E, Borghi A, Bonetti L, Fontana PL, Cappelli S. Riata silicone defibrillation lead with normal electrical measures at routine ambulatory check: The role of high-voltage shock testing. World J Cardiol 2016; 8:657-666. [PMID: 27957252 PMCID: PMC5124724 DOI: 10.4330/wjc.v8.i11.657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/21/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe our experience with shock testing for the evaluation of patients with Riata™ leads.
METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation (VF) induction and in 5 cases a R-wave-synchronized shock (> 20 J, without inducing VF). The test was performed under sedation with Midazolam.
RESULTS Twelve patients (80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients (20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance (< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt VF.
CONCLUSION In Riata™ leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing.
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Parkash R, Thibault B, Mangat I, Coutu B, Bennett M, Healey J, Verma A, Philippon F, Sandhu R, Cameron D, Ayala-Paredes F, Sterns L, Essebag V, Kus T, Nery P, Stephenson E, Yee R, Exner D, Toal S, Birnie D, Wells G, Krahn A. Canadian Registry of Implantable Electronic Device Outcomes. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004282. [DOI: 10.1161/circep.116.004282] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/16/2016] [Indexed: 11/16/2022]
Abstract
Background—
The Riata lead under advisory has posed a unique clinical scenario where inside-out abrasion results in externalization of conductor cables, with a higher risk of electrical failure. We developed a comprehensive registry to assist with clinical management of this lead.
Methods and Results—
This Canadian registry reports the findings of 3763 (74.2% of all Riata leads in Canada) Riata leads under advisory, with a mean follow-up time of 8.9±1.5 years. The overall electrical failure rate was 5.2% at 8 years, with no difference between 7-French and 8-French lead models. Cable externalization was found to be more common in the 8-French model (12.3% versus 5.2%,
P
<0.0001) and was associated with a higher risk of electrical failure. Predictors of electrical lead failure included cable externalization, higher left ventricular ejection fraction, younger age, higher body mass index, and a passive fixation lead. One patient died due to electrical failure, a further 2 patients survived an event where the device failed to deliver high-voltage therapy. Major complications because of lead extraction were higher when compared with lead abandonment, no difference among lead model observed. Two deaths occurred as a consequence of lead extraction, in the context of an underlying infection.
Conclusions—
The Riata lead under advisory has a steady electrical failure rate over time. There are identifiable predictors of lead failure that can assist with clinical decisions as to whether lead revision should be performed prophylactically.
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Affiliation(s)
| | | | - Iqwal Mangat
- For the author affiliations, please see the Appendix
| | - Benoit Coutu
- For the author affiliations, please see the Appendix
| | | | | | - Atul Verma
- For the author affiliations, please see the Appendix
| | | | | | | | | | | | - Vidal Essebag
- For the author affiliations, please see the Appendix
| | - Teresa Kus
- For the author affiliations, please see the Appendix
| | - Pablo Nery
- For the author affiliations, please see the Appendix
| | | | - Raymond Yee
- For the author affiliations, please see the Appendix
| | - Derek Exner
- For the author affiliations, please see the Appendix
| | - Satish Toal
- For the author affiliations, please see the Appendix
| | - David Birnie
- For the author affiliations, please see the Appendix
| | - George Wells
- For the author affiliations, please see the Appendix
| | - Andrew Krahn
- For the author affiliations, please see the Appendix
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29
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Swerdlow CD, Kalahasty G, Ellenbogen KA. Implantable Cardiac Defibrillator Lead Failure and Management. J Am Coll Cardiol 2016; 67:1358-68. [PMID: 26988958 DOI: 10.1016/j.jacc.2015.12.067] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 12/20/2022]
Abstract
The implantable-cardioverter defibrillator (ICD) lead is the most vulnerable component of the ICD system. Despite advanced engineering design, sophisticated manufacturing techniques, and extensive bench, pre-clinical, and clinical testing, lead failure (LF) remains the Achilles' heel of the ICD system. ICD LF has a broad range of adverse outcomes, ranging from intermittent inappropriate pacing to proarrhythmia leading to patient mortality. ICD LF is often considered in the context of design or construction defects, but is more appropriately considered in the context of the finite service life of a mechanical component placed in chemically stressful environment and subjected to continuous mechanical stresses. This clinical review summarizes LF mechanisms, assessment, and differential diagnosis of LF, including lead diagnostics, recent prominent lead recalls, and management of LF and functioning, but recalled leads. Despite recent advances in lead technology, physicians will likely continue to need to understand how to manage patients with transvenous ICD leads.
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Affiliation(s)
| | - Gautham Kalahasty
- Division of Cardiology, Virgina Commonwealth University (VCU) School of Medicine, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiology, Virgina Commonwealth University (VCU) School of Medicine, Richmond, Virginia.
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Good ED, Cakulev I, Orlov MV, Hirsh D, Simeles J, Mohr K, Moll P, Bloom H. Long-Term Evaluation of Biotronik Linox and Linox(smart) Implantable Cardioverter Defibrillator Leads. J Cardiovasc Electrophysiol 2016; 27:735-42. [PMID: 26990515 DOI: 10.1111/jce.12971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Expert consensus holds that post-market, systematic surveillance of ICD leads is essential to ensure confirmation of adequate lead performance. GALAXY (NCT00836589) and CELESTIAL (NCT00810264) are ongoing multicenter, prospective, non-randomized registries conducted to confirm the long-term safety and reliability of Biotronik leads. METHODS AND RESULTS ICD and CRT-D patients are followed for Linox and Linox(smart) ICD lead performance and safety for 5 years post-implant. All procedural and system-related adverse events (AEs) were assessed at each follow-up, along with lead electrical parameters. An independent CEC of EPs adjudicated AEs to determine AE category and lead relatedness. The analysis used categories of lead observations per ISO 5841-2 (Third edition). A total of 3,933 leads were implanted in 3,840 patients (73.0% male, mean age 67.0 ± 12.2 years) at 146 US centers. The estimated cumulative survival probability was 96.3% at 5 years after implant for Linox leads and 96.6% at 4 years after implant for Linox(smart) leads. A comparison of the Linox and Linox(smart) survival functions did not find evidence of a difference (P = 0.2155). The most common AEs were oversensing (23, 0.58%), conductor fracture (14, 0.36%), failure to capture (13, 0.33%), lead dislodgement (12, 0.31%), insulation breach (10, 0.25%), and abnormal pacing impedance (8, 0.20%). CONCLUSIONS Linox and Linox(smart) ICD leads are safe, reliable and infrequently associated with lead-related AEs. Additionally, estimated cumulative survival probability is clinically acceptable and well within industry standards. Ongoing data collection will confirm the longer-term safety and performance of the Linox family of ICD leads.
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Affiliation(s)
- Eric D Good
- University of Michigan, Ann Arbor, Michigan, USA
| | - Ivan Cakulev
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | | | | | | | | | - Heather Bloom
- Emory University and Atlanta VA Medical Center, Atlanta, Georgia, USA
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Ziacchi M, Corzani A, Diemberger I, Martignani C, Marziali A, Mazzotti A, Massaro G, Rapezzi C, Biffi M, Boriani G. Electrocardiographic Eligibility for Subcutaneous Implantable Cardioverter Defibrillator: Evaluation during Bicycle Exercise. Heart Lung Circ 2016; 25:476-83. [DOI: 10.1016/j.hlc.2015.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/08/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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Jo U, Kim J, Hwang YM, Lee JH, Kim MS, Choi HO, Lee WS, Kwon CH, Ko GY, Yoon HK, Nam GB, Choi KJ, Kim YH. Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction. Korean Circ J 2016; 46:186-96. [PMID: 27014349 PMCID: PMC4805563 DOI: 10.4070/kcj.2016.46.2.186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction. Subjects and Methods The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups. Results The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B. Conclusion Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.
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Affiliation(s)
- Uk Jo
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Mi Hwang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyun Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Woo-Seok Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hee Kwon
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Atreya AR, Cook JR, Lindenauer PK. Complications arising from cardiac implantable electrophysiological devices: review of epidemiology, pathogenesis and prevention for the clinician. Postgrad Med 2016; 128:223-30. [DOI: 10.1080/00325481.2016.1151327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Providência R, Kramer DB, Pimenta D, Babu GG, Hatfield LA, Ioannou A, Novak J, Hauser RG, Lambiase PD. Transvenous Implantable Cardioverter-Defibrillator (ICD) Lead Performance: A Meta-Analysis of Observational Studies. J Am Heart Assoc 2015; 4:e002418. [PMID: 26518666 PMCID: PMC4845221 DOI: 10.1161/jaha.115.002418] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the widespread use of implantable cardioverter-defibrillators (ICDs) in clinical practice, concerns exist regarding ICD lead durability. The performance of specific lead designs and factors determining this in large populations need clarification. METHODS AND RESULTS The Medline, Embase, and Cochrane Collaboration databases were searched for studies including ≥2 of the most commonly implanted leads. The Mantel-Haenszel random-effects model was used. Seventeen studies were selected, including a total of 49 871 patients-5538 implanted with Durata (St. Jude Medical Inc), 10 605 with Endotak Reliance (Boston Scientific), 16 119 with Sprint Quattro (Medtronic Corp), 11 709 with Sprint Fidelis (Medtronic Corp), and 5900 with Riata (St. Jude Medical Inc)-with follow-up of 136 509 lead-years. Although the Durata lead presented a numerically higher rate, no statistically significant differences in the mean incidence of lead failure (0.29%-0.45% per year) were observed in comparison of the 3 nonrecalled leads. A higher event rate was documented with the Riata (1.0% per-year increase) and Sprint Fidelis (>2.0% per-year increase) leads compared with nonrecalled leads. An indication of increased incidence of Durata lead failure versus Sprint Quattro and Endotak Reliance leads was observed in 1 of 3 included studies, allowing for comparison of purely electrical lead failure, but this requires further evaluation. CONCLUSIONS Endotak Reliance (8F), Sprint Quattro (8F), and Durata (7F) leads displayed low annual incidence of failure; however, long-term follow-up data are still scarce. More data are needed to clarify the performance and safety of the Durata lead.
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Affiliation(s)
- Rui Providência
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Daniel B. Kramer
- Cardiac ElectrophysiologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Dominic Pimenta
- University College of London Hospitals NHS TrustLondonUnited Kingdom
| | - Girish G. Babu
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
| | | | | | - Jan Novak
- Solothurner Spitaeler AGSolothurnSwitzerland
| | | | - Pier D. Lambiase
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
- University College of LondonUnited Kingdom
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
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Remote monitoring of implantable devices: Should we continue to ignore it? Int J Cardiol 2015; 202:368-77. [PMID: 26432486 DOI: 10.1016/j.ijcard.2015.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/31/2015] [Accepted: 09/19/2015] [Indexed: 11/23/2022]
Abstract
The number of patients with implantable cardioverter defibrillators (ICDs) is increasing. In addition to improve survival, ICD can collect data related to device function and physiological parameters. Remote monitoring (RM) of these data allows early detection of technical or clinical problems and a prompt intervention (reprogramming device or therapy adjustment) before the patient require hospitalization. RM is not a substitute for emergency service and its consultation is now limited during working hours. Thus, a consent form is required to inform patients about benefits and limitations. The available studies indicate that remote monitoring is more effective than traditional calendar face to face based encounters. RM is safe, highly reliable, cost efficient, allows quick reply to failures, and reduces the number of scheduled visits and the incidence of inappropriate shocks with a positive impact on survival. It follows that RM has the credentials to be the standard of care for ICD management; however, unfortunately, there is a delay in physician acceptance and implementation. The recent observations from randomized IN-TIME study that showed a clear survival benefit with RM in heart failure patients have encouraged us to review both the negative and positive aspects of RM collected in a little more than a decade.
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Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: A systematic review and meta-analysis of inappropriate shocks and complications. Heart Rhythm 2015; 13:443-54. [PMID: 26385533 DOI: 10.1016/j.hrthm.2015.09.010] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are implanted with the intention to prolong life in selected patients with inherited arrhythmia syndromes, but ICD implantation is also associated with inappropriate shocks and complications. OBJECTIVE We aimed to quantify the rate of inappropriate shocks and other ICD-related complications to be able to weigh benefit and harm in these patients. METHODS We performed a systematic review and meta-analysis of inappropriate shock and/or other ICD-related complication rates, including ICD-related mortality, in patients with inherited arrhythmia syndromes, that is, arrhythmogenic right ventricular cardiomyopathy/dysplasia, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, dilated cardiomyopathy due to a mutation in the lamin A/C gene, long QT syndrome, and short QT syndrome. We searched MEDLINE and EMBASE from inception to May 30, 2014. RESULTS Of 2471 unique citations, 63 studies comprising 4916 patients with inherited arrhythmia syndromes (mean age of 39 ± 15 years) were included. Inappropriate shocks occurred in 20% of patients (crude annual rate of 4.7% per year), with a significantly higher rate in studies published before 2008 (6.1% per year vs 4.1% per year). Moreover, 22% experienced ICD-related complications (4.4% per year) and there was a 0.5% ICD-related mortality (0.08% per year). CONCLUSION ICD implantation carries a significant risk of inappropriate shocks and inhospital and postdischarge complications in relatively young patients with inherited arrhythmia syndromes. These data can be used to better inform patients and physicians about the expected risk of adverse ICD events and thereby facilitate shared decision making.
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Kollmann DT, Swerdlow CD, Kroll MW, Seifert GJ, Lichter PA, Hedin DS, Panescu D. ICD lead failure detection in chronic soaked leads. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:5667-5671. [PMID: 26737578 DOI: 10.1109/embc.2015.7319678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Abrasion-induced insulation breach is a common failure mode of silicone-body, transvenous, implantable cardioverter defibrillator leads. It is caused either by external compression or internal motion of conducting cables. The present method of monitoring lead integrity measures low frequency conductor impedance. It cannot detect insulation failures until both the silicone lead body and inner fluoropolymer insulation have been breached completely, exposing conductors directly to blood or tissue. Even then the resistance changes are usually swamped by the baseline values. Thus the first clinical presentation may be either failure to deliver a life-saving shock or painful, inappropriate shocks in normal rhythm. We have previously presented a method for identifying early lead failure based on high frequency transmission line impedance measurements. That work used fresh leads in a liquid simulation bath; we have now demonstrated similar effects in leads soaked for 32 days and hence with saline-saturated silicone lead bodies.
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Kramer DB, Hatfield LA, McGriff D, Ellis CR, Gura MT, Samuel M, Retel LK, Hauser RG. Transvenous implantable cardioverter-defibrillator lead reliability: implications for postmarket surveillance. J Am Heart Assoc 2015; 4:e001672. [PMID: 26025935 PMCID: PMC4599526 DOI: 10.1161/jaha.114.001672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background As implantable cardioverter-defibrillator technology evolves, clinicians and patients need reliable performance data on current transvenous implantable cardioverter-defibrillator systems. In addition, real-world reliability data could inform postmarket surveillance strategies directed by regulators and manufacturers. Methods and Results We evaluated Medtronic Sprint Quattro, Boston Scientific Endotak, and St Jude Medical Durata and Riata ST Optim leads implanted by participating center physicians between January 1, 2006 and September 1, 2012. Our analytic sample of 2653 patients (median age 65, male 73%) included 445 St Jude, 1819 Medtronic, and 389 Boston Scientific leads. After a median of 3.2 years, lead failure was 0.28% per year (95% CI, 0.19 to 0.43), with no statistically significant difference among manufacturers. Simulations based on these results suggest that detecting performance differences among generally safe leads would require nearly 10 000 patients or very long follow-up. Conclusions Currently marketed implantable cardioverter-defibrillator leads rarely fail, which may be reassuring to clinicians advising patients about risks and benefits of transvenous implantable cardioverter-defibrillator systems. Regulators should consider the sample size implications when designing comparative effectiveness studies and evaluating new technology for preventing sudden cardiac death.
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Affiliation(s)
- Daniel B Kramer
- Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., M.S.) Hebrew SeniorLife Institute for Aging Research, Boston, MA (D.B.K.) Harvard Medical School, Boston, MA (D.B.K., L.A.H.)
| | | | - Deepa McGriff
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
| | | | - Melanie T Gura
- Northeast Ohio Cardiovascular Specialists, Akron, OH (M.T.G.)
| | - Michelle Samuel
- Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., M.S.)
| | - Linda Kallinen Retel
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
| | - Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
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Phan K, Kabunga P, Kilborn MJ, Sy RW. Defibrillator Threshold Testing at Generator Replacement: Is it Time to Abandon the Practice? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:777-81. [PMID: 25790073 DOI: 10.1111/pace.12630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/09/2015] [Accepted: 03/12/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter Kabunga
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Kilborn
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Raymond W Sy
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Bongiorni MG, Di Cori A, Segreti L, Zucchelli G, Viani S, Paperini L, De Lucia R, Levorato D, Boem A, Soldati E. Transvenous extraction profile of Riata leads: Procedural outcomes and technical complexity of mechanical removal. Heart Rhythm 2015; 12:580-587. [DOI: 10.1016/j.hrthm.2014.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Indexed: 11/25/2022]
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Swerdlow CD, Asirvatham SJ, Ellenbogen KA, Friedman PA. Troubleshooting implanted cardioverter defibrillator sensing problems I. Circ Arrhythm Electrophysiol 2015; 7:1237-61. [PMID: 25516582 DOI: 10.1161/circep.114.002344] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Charles D Swerdlow
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.).
| | - Samuel J Asirvatham
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Kenneth A Ellenbogen
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Paul A Friedman
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
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Kollmann DT, Swerdlow CD, Kroll MW, Seifert GJ, Lichter PA. ICD lead failure detection through high frequency impedance. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6487-92. [PMID: 25571482 DOI: 10.1109/embc.2014.6945114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abrasion-induced insulation breach is a common failure mode of silicone-body, transvenous, implantable cardioverter defibrillator leads. It is caused either by external compression or internal motion of conducting cables. The present method of monitoring lead integrity measures low frequency conductor impedance. It cannot detect insulation failures until both the silicone lead body and inner fluoropolymer insulation have been breached completely, exposing conductors directly to blood or tissue. Thus the first clinical presentation may be either failure to deliver a life-saving shock or painful, inappropriate shocks in normal rhythm. We present a new method for identifying lead failure based on high frequency impedance measurements. This method was evaluated in 3D electromagnetic simulation and bench testing to identify insulation defects in the St. Jude Medical Riata® lead, which is prone to insulation breach.
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Successful detection of a high-energy electrical short circuit and a "rescue" shock using a novel automatic shocking-vector adjustment algorithm. HeartRhythm Case Rep 2015; 1:27-30. [PMID: 28491504 PMCID: PMC5420061 DOI: 10.1016/j.hrcr.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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STEINBERG CHRISTIAN, SARRAZIN JEANFRANÇOIS, PHILIPPON FRANÇOIS, CHAMPAGNE JEAN, MOLIN FRANCK, NAULT ISABELLE, BLIER LOUIS, BOUCHARD MARCANDRÉ, ARSENAULT JEAN, O'HARA GILLES. PA/Lateral Chest X-Ray is Equivalent to Cine-Fluoroscopy for the Detection of Conductor Externalization in Defibrillation Leads. Pacing Clin Electrophysiol 2015; 38:77-83. [DOI: 10.1111/pace.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/01/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Affiliation(s)
- CHRISTIAN STEINBERG
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - JEAN-FRANÇOIS SARRAZIN
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - FRANÇOIS PHILIPPON
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - JEAN CHAMPAGNE
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - FRANCK MOLIN
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - ISABELLE NAULT
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - LOUIS BLIER
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - MARC-ANDRÉ BOUCHARD
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - JEAN ARSENAULT
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
| | - GILLES O'HARA
- Division of Electrophysiology; Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ); Québec Canada
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Parkash R, Tung S, Champagne J, Healey JS, Thibault B, Cameron D, Tang A, Connors S, Beardsall M, Mangat I, Ayala-Paredes F, Toal S, Exner D, Yee R, Krahn AD. Insight into the mechanism of failure of the Riata lead under advisory. Heart Rhythm 2014; 12:574-579. [PMID: 25485777 DOI: 10.1016/j.hrthm.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cable externalization and insulation abrasion are known to occur with the St Jude Medical Riata leads under advisory. The distribution of these abnormalities and how they relate to clinical presentation have not been well described. OBJECTIVE In this study, we sought to determine the relationship between structural lead failure and clinical presentation by using the analysis of returned Riata products in Canada. METHODS The analyses of returned Riata products in Canada were obtained from St Jude Medical, Sylmar, CA. These data were correlated with the clinical presentation of patients just before lead removal from service. RESULTS As of May 1, 2013, there were 263 returned Riata leads in Canada. Of these, 43 (16.8%) were found to have insulation abrasion that was due to either lead-can or lead-other device interaction (70%) or inside-out abrasion (27.9%). The predilection of lead-to-can abrasion was seen in the Riata 7-F leads (84.2% vs 58.4%; P = .07), while inside-out abrasion was more common in the Riata 8-F leads (37.5% vs 15.8%; P = .12). Electrical abnormalities were frequent (20 of 31 [65.4%]) and most often due to electrical noise (45.2%), although inappropriate shocks were present (25.8%). Death occurred in 1 of 43 (2.3%) of those patients with an insulation defect in the lead-can abrasion group. CONCLUSION Lead-can abrasion is the most common form of insulation defect in the Riata group of leads under advisory. Management of this group of leads under advisory should not neglect the issue of lead-can abrasion, in addition to detection of cable externalization.
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Affiliation(s)
- Ratika Parkash
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada.
| | - Stanley Tung
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jean Champagne
- Quebec Heart Institute, Laval Hospital, Quebec City, Quebec, Canada
| | | | | | | | - Anthony Tang
- London Health Sciences Center, London, Ontario, Canada
| | - Sean Connors
- Memorial University Health Sciences Center, St John's Newfoundland, Canada
| | | | | | | | - Satish Toal
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Derek Exner
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Raymond Yee
- London Health Sciences Center, London, Ontario, Canada
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
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Prospective long-term evaluation of Optim-insulated (Riata ST Optim and Durata) implantable cardioverter-defibrillator leads. Heart Rhythm 2014; 11:2156-62. [DOI: 10.1016/j.hrthm.2014.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Indexed: 11/19/2022]
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Larsen JM, Nielsen JC, Johansen JB, Haarbo J, Petersen HH, Thøgersen AM, Hjortshøj SP. Prospective nationwide fluoroscopic and electrical longitudinal follow-up of recalled Riata defibrillator leads in Denmark. Heart Rhythm 2014; 11:2141-7. [DOI: 10.1016/j.hrthm.2014.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Indexed: 11/25/2022]
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Shenthar J, Ghanta S, Rai MK, Walia R. Riata lead failure presenting as a life-threatening electrical storm: A novel manifestation of electrical lead failure. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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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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