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Nair SG, Swerdlow CD. Monitoring for and Diagnosis of Lead Dysfunction. Card Electrophysiol Clin 2018; 10:573-599. [PMID: 30396573 DOI: 10.1016/j.ccep.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ploux S, Swerdlow CD, Strik M, Welte N, Klotz N, Ritter P, Haïssaguerre M, Bordachar P. Towards eradication of inappropriate therapies for ICD lead failure by combining comprehensive remote monitoring and lead noise alerts. J Cardiovasc Electrophysiol 2018; 29:1125-1134. [PMID: 29858871 DOI: 10.1111/jce.13653] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 05/01/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Recognition of implantable cardioverter defibrillator (ICD) lead malfunction before occurrence of life threatening complications is crucial. We aimed to assess the effectiveness of remote monitoring associated or not with a lead noise alert for early detection of ICD lead failure. METHODS From October 2013 to April 2017, a median of 1,224 (578-1,958) ICD patients were remotely monitored with comprehensive analysis of all transmitted materials. ICD lead failure and subsequent device interventions were prospectively collected in patients with (RMLN) and without (RM) a lead noise alert (Abbott Secure Sense™ or Medtronic Lead Integrity Alert™) in their remote monitoring system. RESULTS During a follow-up of 4,457 patient years, 64 lead failures were diagnosed. Sixty-one (95%) of the diagnoses were made before any clinical complication occurred. Inappropriate shocks were delivered in only one patient of each group (3%), with an annual rate of 0.04%. All high voltage conductor failures were identified remotely by a dedicated impedance alert in 10 patients. Pace-sense component failures were correctly identified by a dedicated alert in 77% (17 of 22) of the RMLN group versus 25% (8 of 32) of the RM group (P = 0.002). The absence of a lead noise alert was associated with a 16-fold increase in the likelihood of initiating either a shock or ATP (OR: 16.0, 95% CI 1.8-143.3; P = 0.01). CONCLUSION ICD remote monitoring with systematic review of all transmitted data is associated with a very low rate of inappropriate shocks related to lead failure. Dedicated noise alerts further reduce inappropriate detection of ventricular arrhythmias.
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Affiliation(s)
- Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
| | - Charles D Swerdlow
- Cedars-Sinai Heart Center, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Marc Strik
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Physiology and Cardiology Department, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nicolas Welte
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France
| | - Philippe Ritter
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
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Zaman JAB, Chua K, Sovari AA, Gunderson B, Gang ES, Ploux S, Swerdlow CD. Early Diagnosis of Defibrillation Lead Dislodgement. JACC Clin Electrophysiol 2018; 4:1075-1088. [PMID: 30139490 DOI: 10.1016/j.jacep.2018.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/09/2018] [Accepted: 03/22/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study sought to develop and evaluate an algorithm for early diagnosis of dislodged implantable cardioverter-defibrillator (ICD) leads. BACKGROUND Dislodged defibrillation leads may sense atrial and ventricular electrograms (EGMs), triggering shocks in the vulnerable period that induce ventricular fibrillation (VF). METHODS We developed a 2-step algorithm by using experimental lead dislodgements (LDs) at ICD implantation and a control dataset of newly implanted, in situ leads. Step 1 consisted of an alert triggered by abrupt decrease in R-wave amplitude and increase in pacing threshold. Step 2 withheld therapy based on ventricular EGM evidence of LD identified from experimental LD behavior. We estimated the algorithm's performance using a registry dataset of 3,624 new implantations and an atrial dislodgement dataset of 14 LDs at the atrium. RESULTS In the registry dataset, the algorithm identified 20 of 21 radiographic LDs (95%) at a median of 11 days before clinical diagnosis. Step 1 had positive predictive values of 57% for radiographic LD and 77% for surgical revision. The false positive rate was 0.4% after step 1 and ≤0.2% after step 2. In the atrial dislodgement dataset, step 1 identified all 14 LDs; step 2 would have prevented inappropriate therapy in all 7 patients with stored EGMs at LD, including 2 patients with fatal, shock-induced VF. CONCLUSIONS An ICD algorithm can facilitate early diagnosis of defibrillation LD. Additional data are needed to determine the safety of withholding shocks based on EGM evidence of LD.
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Affiliation(s)
- Junaid A B Zaman
- Cardiac Electrophysiology, Cedars-Sinai Heart Center, Cedars-Sinai Medical Center, Los Angeles California
| | - Kelvin Chua
- Cardiac Electrophysiology, Cedars-Sinai Heart Center, Cedars-Sinai Medical Center, Los Angeles California
| | - Ali A Sovari
- Cardiac Electrophysiology, Cedars-Sinai Heart Center, Cedars-Sinai Medical Center, Los Angeles California
| | | | - Eli S Gang
- Cardiac Electrophysiology, Cedars-Sinai Heart Center, Cedars-Sinai Medical Center, Los Angeles California
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Centre Hospitalier Universitaire, Bordeaux, Université Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque, Bordeaux, France
| | - Charles D Swerdlow
- Cardiac Electrophysiology, Cedars-Sinai Heart Center, Cedars-Sinai Medical Center, Los Angeles California.
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Nishii N, Miyoshi A, Kubo M, Miyamoto M, Morimoto Y, Kawada S, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. Analysis of arrhythmic events is useful to detect lead failure earlier in patients followed by remote monitoring. J Cardiovasc Electrophysiol 2017; 29:463-470. [DOI: 10.1111/jce.13399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nobuhiro Nishii
- Department of Cardiovascular Therapeutics; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Motoki Kubo
- Department of Cardiovascular Medicine; Fukuyama City Hospital; Fukuyama Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Yoshimasa Morimoto
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
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Maddox TM, Albert NM, Borden WB, Curtis LH, Ferguson TB, Kao DP, Marcus GM, Peterson ED, Redberg R, Rumsfeld JS, Shah ND, Tcheng JE. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e826-e857. [DOI: 10.1161/cir.0000000000000480] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.
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Sennhauser S, Anand R, Kusumoto F, Goldschlager N. Heart Rhythm Society: expert consensus statements-part 1. Clin Cardiol 2017; 40:177-185. [PMID: 28273360 DOI: 10.1002/clc.22666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 01/06/2023] Open
Abstract
One of the most important roles for professional societies in medicine is assembling multiple stakeholders and experts to develop documents that can help guide and define policies and strategies for best medical care. Each year the Heart Rhythm Society (HRS) develops several consensus documents that address critical clinical subjects that have been identified by input from HRS members and HRS committees. Over the past 5 years, HRS has produced documents with multiple professional societies from around the world, and although the topics chosen for exploration center around arrhythmia management, the reviews and recommendations made in the documents are important for clinical cardiologists and generalists who are not arrhythmia specialists. When an internist or other primary care provider identifies a patient who may be having symptoms from an arrhythmia, the referral first is made to the clinical cardiologist and only later, if necessary, does an arrhythmia specialist become involved. These expert consensus statements are developed for specific clinical questions regarding arrhythmia management where there is controversy or uncertainty, often with less data from randomized controlled trials to help guide recommendations, which must then be made by extrapolation of existing data, observational data, and expert opinion. In this 2-part review, the consensus statements developed by the HRS over the past 5 years that pertain to adults are discussed in part 1; part 2 focuses on consensus statements that HRS has developed in conjunction with the Pediatric and Congenital Electrophysiology Society that address arrhythmia issues in children and adults with congenital heart disease.
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Affiliation(s)
- Susie Sennhauser
- University of Miami Miller School of Medicine, Holy Cross Hospital, Fort Lauderdale, Florida
| | - Rishi Anand
- University of Miami Miller School of Medicine, Holy Cross Hospital, Fort Lauderdale, Florida
| | - Fred Kusumoto
- Electrophysiology and Pacing Service, Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Nora Goldschlager
- Cardiology Division, Department of Medicine, San Francisco General Hospital, San Francisco, California.,Department of Medicine, University of California, San Francisco, San Francisco, California
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Zhu DWX, Chu MM, House CM. Management of functional Sprint Fidelis leads at cardiac resynchronization therapy-defibrillator generator replacement: a novel option for preventing inappropriate shocks from lead failure in fragile patients with high risk of sudden death†. Europace 2016; 19:2007-2014. [DOI: 10.1093/europace/euw311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/03/2016] [Indexed: 11/13/2022] Open
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Yazaki K, Ajiro Y, Hasegawa S, Watanabe M, Tsukamoto K, Mizobuchi K, Saito T, Mori F, Iwade K. Myopotential oversensing notified by Lead Integrity Alert in a patient with implantable cardioverter defibrillator with a dedicated bipolar epicardial sensing lead. Clin Case Rep 2016; 4:1091-1095. [PMID: 27980739 PMCID: PMC5134266 DOI: 10.1002/ccr3.696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/01/2016] [Accepted: 07/14/2016] [Indexed: 11/09/2022] Open
Abstract
Although myopotential oversensing by a dedicated bipolar lead is rare, an epicardial lead on a dilated ventricle might contribute to its sensitivity. Myopotential oversensing was notified by the Lead Integrity Alert in this case. We should be aware of this possibility for the management of such patients.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Yoichi Ajiro
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Shun Hasegawa
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Masahiro Watanabe
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Kei Tsukamoto
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Keiko Mizobuchi
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Takashi Saito
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Fumiaki Mori
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
| | - Kazunori Iwade
- Department of CardiologyNational Hospital Organization Yokohama Medical Center3‐60‐2 HarajukuTotsuka‐kuYokohama‐shi245‐8575KanagawaJapan
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9
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HU YUHNINGL, KASZALA KAROLY, HUIZAR JOSE, ELLENBOGEN KENNETHA, TAN ALEXY. Repetitive Periodic Atrial Oversensing in a Cardiac Implantable Electrical Defibrillator at 35 Minutes and 50 Minutes Past the Hour: What Is the Diagnosis? Pacing Clin Electrophysiol 2016; 39:1018-21. [DOI: 10.1111/pace.12914] [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: 04/05/2016] [Revised: 05/24/2016] [Accepted: 06/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- YUHNING L. HU
- Clinical Cardiac Electrophysiology, Pauley Heart Center; Virginia Commonwealth University; Richmond Virginia
- Division of Cardiology, Electrophysiology Section; Hunter Holmes McGuire VA Medical Center; Richmond Virginia
| | - KAROLY KASZALA
- Clinical Cardiac Electrophysiology, Pauley Heart Center; Virginia Commonwealth University; Richmond Virginia
- Division of Cardiology, Electrophysiology Section; Hunter Holmes McGuire VA Medical Center; Richmond Virginia
| | - JOSE HUIZAR
- Clinical Cardiac Electrophysiology, Pauley Heart Center; Virginia Commonwealth University; Richmond Virginia
- Division of Cardiology, Electrophysiology Section; Hunter Holmes McGuire VA Medical Center; Richmond Virginia
| | - KENNETH A. ELLENBOGEN
- Clinical Cardiac Electrophysiology, Pauley Heart Center; Virginia Commonwealth University; Richmond Virginia
| | - ALEX Y. TAN
- Clinical Cardiac Electrophysiology, Pauley Heart Center; Virginia Commonwealth University; Richmond Virginia
- Division of Cardiology, Electrophysiology Section; Hunter Holmes McGuire VA Medical Center; Richmond Virginia
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10
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Brown ML, Swerdlow CD. Sensing and detection in Medtronic implantable cardioverter defibrillators. Herzschrittmacherther Elektrophysiol 2016; 27:193-212. [PMID: 27624809 DOI: 10.1007/s00399-016-0450-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/03/2016] [Indexed: 06/06/2023]
Abstract
Ensuring sensing and detection of ventricular tachycardia (VT) and ventricular fibrillation (VF) was a prerequisite for the clinical trials that established the survival benefit of implantable cardioverter defibrillators (ICDs). However, for decades, a high incidence of unnecessary shocks limited patients' and physicians' acceptance of ICD therapy. Oversensing, misclassification of supraventricular tachycardia (SVT) as VT, and self-terminating VT accounted for the vast majority of unnecessary shocks. Medtronic ICDs utilize sensitive baseline settings with minimal blanking periods to ensure accurate sensing of VF, VT, and SVT electrograms. Programmable algorithms reject oversensing caused by far-field R waves, T waves, and non-physiologic signals caused by lead failure. A robust hierarchy of SVT-VT discriminators minimize misclassification of SVT as VT. These features, combined with evidence-based programming, have reduced the 1‑year inappropriate shock rate to 1.5 % for dual-/triple-chamber ICDs and to 2.5 % for single-chamber ICDs.
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Affiliation(s)
- Mark L Brown
- Medtronic plc., 8200 Coral Sea St NE, MS MVN41, 55112, Mounds View, MN, USA.
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11
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
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Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
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Ahmed I, Patel AS, Balgaard TJ, Rosenfeld LE. Technician-Supported Remote Interrogation of CIEDs: Initial Use in US Emergency Departments and Perioperative Areas. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:275-81. [PMID: 26647906 DOI: 10.1111/pace.12798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/29/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Interrogation/interpretation of cardiac implantable electronic devices (CIEDs) is frequently required in the emergency department (ED) or perioperative areas (OR) where resources to do this are often not available. CareLink Express (CLE; Medtronic, plc, Mounds View, MN, USA) is a technician-supported real-time remote interrogation system for Medtronic CIEDs. Using data from 136 US locations, this retrospective study was designed to assess CLE efficiency compared to traditional device management, and examine its findings. METHODS All 7,044 US CLE transmissions from the ED and OR (January 2012-October 2014) were compared to 217 traditional requests where CIED interrogations/interpretations were performed by calling industry representatives to these sites. RESULTS CLE reduced the time to device interrogation/interpretation by 78%: 100 ± 140-22 ± 14 minutes, P < 0.0001, improving response time and consistency; ED: 82 ± 103-23 ± 18 minutes, P, ≤ 0.01; OR: 127 ± 181-17 ± 10 minutes, P < 0.0001. Actionable events (AE) (arrhythmia, device/lead abnormalities) were infrequent: 9.1% overall (ED: 9.9%; OR: 4.1%). Only 6.5% of patients with syncope/presyncope and 13.6% with a perceived shock had AE. AEs were more common in those with suspected device problems (30.4%) or audible alerts (52.6%). They were more likely in patients not enrolled in long-term remote monitoring (23.9% vs 8.2%, P < 0.0001) and in those with older CIED systems (7.4% in year 1 vs 31.0% after 10 years). CONCLUSIONS The many patients with CIEDs, and the ability to quickly identify the minority with high-risk AE from the no/low-risk majority, strongly support CLE use in the ED and OR, sites which are expensive and prioritize efficiency.
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Affiliation(s)
- Imdad Ahmed
- Yale University School of Medicine, New Haven, Connecticut
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2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2015; 13:e50-86. [PMID: 26607062 DOI: 10.1016/j.hrthm.2015.11.018] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/12/2022]
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14
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, Mcguire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace 2015; 18:159-83. [PMID: 26585598 DOI: 10.1093/europace/euv411] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Souissi Z, Guédon-Moreau L, Boulé S, Kouakam C, Finat L, Marquié C, Brigadeau F, Wissocque L, Mouton S, Montaigne D, Klug D, Kacet S, Lacroix D. Impact of remote monitoring on reducing the burden of inappropriate shocks related to implantable cardioverter-defibrillator lead fractures: insights from a French single-centre registry. Europace 2015; 18:820-7. [DOI: 10.1093/europace/euv284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022] Open
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Steinberg C, Padfield GJ, Hahn E, Flavelle S, McILROY C, VAN Bremen O, Yeung-Lai-Wah JA, Kerr CR, Deyell MW, Tung SK, Andrade JG, Bennett MT, Bashir JG, Krahn AD, Chakrabarti S. Lead Integrity Alert Is Useful for Assessment of Performance of Biotronik Linox Leads. J Cardiovasc Electrophysiol 2015; 26:1340-5. [PMID: 26471861 DOI: 10.1111/jce.12832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Medtronic's Lead Integrity Alert (LIA) software algorithm is useful for detecting abnormal parameters across various ICD-lead families. However, its utility in the assessment of the Biotronik Linox™ family of high-voltage (HV) leads is unknown. METHODS We conducted a retrospective cohort study to assess the performance of the LIA algorithm to detect abnormalities and lead failure in Linox ICD-leads. All LIA-enabled Medtronic devices connected to an active Linox lead were included. The alerts were adjudicated by 2 blinded electrophysiologists and correlated with clinical data. RESULTS Between 2008 and 2012, data from 208 patients with 564 patient-years of follow-up were available for analysis. The median follow-up duration was 32 (IQR 21-41 months). Twenty-one LIA triggers were noted in 20 different patients. The median delay until a positive LIA was 32 months (IQR 21-41 months) postimplant with a 5-year lead survival free from LIA of 76%. Ninety-five percent (19/20) LIA alerts were true lead failures. The most common LIA triggers were short V-V intervals (85%) and nonsustained ventricular tachycardia (85%). Abrupt changes of the ICD-lead impedance occurred in 5/20 triggers. Inappropriate ICD-shocks were strongly associated with a positive LIA (30% vs. 7.4%; P = 0.006). Of the explanted Linox leads 53% had visible abnormalities. The sensitivity, specificity, and positive predictive value for lead failure in the presence of a LIA trigger were 87%, 99.5%, and 95.2%, respectively. CONCLUSIONS A positive LIA trigger in Biotronik Linox ICD-leads is highly predictive of lead failure. LIA is useful in ongoing surveillance of lead performance.
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Affiliation(s)
- Christian Steinberg
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Gareth J Padfield
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Edna Hahn
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Sheila Flavelle
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Cheryl McILROY
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Otto VAN Bremen
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | | | - Charles R Kerr
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Stanley K Tung
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Matthew T Bennett
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Jamil G Bashir
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
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17
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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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18
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Rosenfeld LE, Patel AS, Ajmani VB, Holbrook RW, Brand TA. Compliance with remote monitoring of ICDS/CRTDS in a real-world population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:820-7. [PMID: 24484075 DOI: 10.1111/pace.12358] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/17/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Remote monitoring (RM) of defibrillators (implantable cardioverter defibrillators [ICDs]) and cardiac resynchronization therapy devices (CRTDs) has been shown to be cost effective, convenient, and associated with reduced mortality and a reduction in the time to physician intervention for actionable events. However, patient compliance with monitoring over time and what factors might influence such compliance have not been well described. This study sought to identify factors contributing to patient noncompliance with RM of ICDs and CRTDs in a large real-world population. METHODS Deidentified data on U.S. patients enrolled in the Medtronic CareLink RM system were used to compare patients with no (noncompliant, n = 14,848) and with ≥ 2 RM transmissions (compliant, n = 103,284) during a 14-month period. RESULTS Overall noncompliance with RM was 21%. Younger age (≤ 40), female sex, wanded device, Medicare Census Division, and small clinic size all predicted patient noncompliance (P < 0.01). Device type (ICD vs CRTD) did not (P = 0.52). Multivariate analysis suggested clinically important predictors of noncompliance to be: age ≤ 40, odds ratio (OR) 2.64 (95% confidence interval, 2.42-2.88); Medicare Census Division (Mountain vs West North Central), OR 2.15 (1.96-2.37); and small clinic size (1-4 vs >100 patients), OR 4.38 (3.92-4.91). CONCLUSIONS There is room for improvement in RM usage among enrolled patients. Younger patients, smaller clinics, and certain geographic areas may be targets for research into interventions to further improve the use of RM.
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Affiliation(s)
- Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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19
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Burri H, Combescure C. Management of recalled implantable cardioverter-defibrillator leads at generator replacement: a decision analysis model for Fidelis leads. ACTA ACUST UNITED AC 2014; 16:1210-7. [DOI: 10.1093/europace/eut425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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20
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21
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Vollmann D, Woronowicz S, Kmiec L, Jung K, Zenker D, Seegers J, Sossalla S, Dorenkamp M, Sohns C, Lüthje L, Hasenfuss G, Zabel M. Passive-fixation lead failure rates and long-term patient mortality in subjects implanted with Sprint Fidelis electrodes. Europace 2013; 16:258-64. [PMID: 23813451 DOI: 10.1093/europace/eut185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate passive-fixation lead failure rates and long-term patient survival in subjects implanted with Sprint Fidelis electrodes. METHODS AND RESULTS We identified 748 subjects who received a Sprint Fidelis (n = 429; Medtronic models 6948: 94.8%, 6949: 2.6%, 6930: 1.9%, 6931: 0.7%) or a Sprint 'non-Fidelis' implantable cardioverter defibrillator lead (n = 319, Medtronic models 6944: 68.6%, 6947: 17.9%, 6942: 7.8%, 6943: 3.4%, 6945: 2.2%) at our centre between 1998 and 2008. Kaplan-Meier patient survival was lower in the Fidelis group than in the Control cohort (68.4 vs. 77.0% at 5 years, P = 0.0061), but multivariate analyses revealed no significant association between mortality and implanted lead type. Passive-fixation lead failure rate at 5 years was 14.4% (95% confidence interval (CI) [9.2, 19.3]) in the Fidelis (n = 414) group and 1.8% (95% CI [0.0-3.8]) in the Control (n = 241) cohort (P < 0.001 upon multivariate comparison). CONCLUSION Failure rates of passive-fixation Sprint Fidelis leads are increased and similar to those previously reported for active-fixation Fidelis electrodes. Despite the elevated risk for lead failure and its potential sequelae, the Sprint Fidelis has no obvious impact on long-term mortality.
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Affiliation(s)
- Dirk Vollmann
- Division of Clinical Electrophysiology, Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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22
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Verlato R, Facchin D, Catanzariti D, Molon G, Zanotto G, Morani G, Brieda M, Zanon F, Delise P, Leoni L, Comisso J, Campo C. Clinical outcomes in patients with implantable cardioverter defibrillators and Sprint Fidelis leads. Heart 2013; 99:799-804. [PMID: 23434626 DOI: 10.1136/heartjnl-2012-303259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The performances of implantable cardioverter defibrillators and leads are important issues for healthcare providers and patients. In 2007 Sprint Fidelis leads were found to be associated with an increased failure rate and so the purpose of the study was to evaluate long-term mortality and clinical outcomes in patients implanted with Sprint Fidelis leads compared with Sprint Quattro leads. DESIGN, SETTING, PATIENTS 508 patients with Sprint Fidelis leads and 468 with Sprint Quattro leads were prospectively followed in 12 Italian cardiology centres. MAIN OUTCOME MEASURES Information on hospitalisations and other clinical events were collected during scheduled and unscheduled hospital visits. Deaths were identified from medical records or via phone contacts with patients' family members or through the National Office of Vital Statistics. RESULTS Over a mean follow-up of 27±18 months 141 deaths occurred in the overall population. No death was observed in patients with diagnosed failing lead. Kaplan-Meier patient survival differed between the two lead groups (80±2% in Fidelis leads vs 70±4% in the Sprint Quattro leads at 4 years, p=0.002). Multivariate analyses showed that mortality was neither associated with lead type nor with diagnosed failed lead. The annual rate of lead failure was 1.8% patient-year for Fidelis leads and 0.2% for the Sprint Quattro leads. CONCLUSIONS In our multicentre research, the clinical outcomes of patients with Fidelis leads differed from those of patients with Sprint Quattro leads. Nevertheless, neither mortality nor the combined endpoint of mortality and heart failure hospitalisations was associated with the lead type. http://clinicaltrials.gov/ct2/show/NCT01007474.
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Affiliation(s)
- Roberto Verlato
- Department of Cardiology, General Hospital Cosma, Via P Cosma 1, Camposampiero 35012, Italy.
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Corcoran SJ, Davis LM. Cardiac Implantable Electronic Device Therapy for Bradyarrhythmias and Tachyarrhythmias. Heart Lung Circ 2012; 21:328-37. [DOI: 10.1016/j.hlc.2012.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/27/2022]
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Abstract
Background—
Approximately 268 000 Fidelis leads were implanted worldwide until distribution was suspended because of a high rate of early failure. Careful analyses of predictors of increased lead failure hazard are required to help direct future lead design and also to inform decision making on lead replacement. We sought to perform a comprehensive analysis of all potential predictors in a multicenter study.
Methods and Results—
A total of 3169 Sprint Fidelis leads were implanted in 11 centers with a total of 251 failures. Lead failure rates at 3, 4, and 5 years were 5.3%, 10.6%, and 16.8%, respectively. The rate of lead failure continues to accelerate (
P
<0.001). There were 4 independent predictors of failure: center, sex, access vein, and previous lead failure. Women had a higher hazard of failure (hazard ratio 1.51; 95% confidence interval, 1.14–2.04;
P
=0.005). Both axillary and subclavian access increased the hazard of failure (
P
=0.007); hazard ratio for axillary was 1.94, (95% confidence interval, 1.23–3.04) and for subclavian 1.63 (95% confidence interval, 1.08–2.46). Previous lead failure increased the hazard of a subsequent Fidelis failure with a hazard ratio of 3.12 (95% confidence interval, 1.80–5.41;
P
<0.001).
Conclusions—
The rate of Fidelis failure continues to increase over time, with failures approaching 17% at 5 years. Women, patients with leads inserted via the subclavian or axillary vein, and those with a previous lead fracture were at greatest risk of Fidelis failure. Our data suggest that Fidelis replacement should be strongly considered at the time of generator replacement.
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Groarke JD, Buckley U, Collison D, O'Neill J, Mahon NG, Foley B. Cost implications of defibrillator lead failures. Europace 2012; 14:1156-60. [DOI: 10.1093/europace/eus006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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