Cable externalization at the proximal portion of the superior vena cava coil in Riata implantable cardioverter defibrillator leads

Abstract

Many Riata implantable cardioverter defibrillator (ICD) leads have reportedly developed cable externalization. The most likely cause of cable externalization is insulation abrasion, which often occurs at the can or between the right ventricular coil and superior vena cava (SVC) coil. We report a rare case of an adult male whose ICD lead cable was externalized at the proximal portion of the SVC coil. This lead became fixed to the wall at the subclavian vein and SVC and became bent between these adhesions. Furthermore, the motion of this lead was affected by pulsation of the aortic arch.The ICD lead might develop inside-out abrasion due to mechanical stress evoked by pulsation of the aortic arch at this site.-3- Leaning objectiveCable externalization of the ICD lead at the proximal portion of the SVC coil has rarely been reported. Externalization might be the result of deformation of the left brachiocephalic vein and the anatomical relationship with the aortic arch. The anatomical pathway of the lead should be carefully considered during the procedure, especially when a dual-coil lead is selected. Moreover, possible cable externalization at both the proximal and distal portions of the SVC coil should be kept in mind during follow-up.-4-

Riata lead up to date

“…Thus, it has been controversial whether externalization is associated with electrical abnormality or not. Because externalization might lead to electrical abnormality, the observation of whole lead portion should be recommended based on this case report [7].…”

“…The externalized portion of the Riata lead was often at device can or between the RV coil and SVC coil. However, in this issue of the Journal of Cardiology Cases, Katsuki et al reported a case [7] in which the externalized portion was proximal to the SVC coil. It was thought to be rare.…”

Transvenous extraction of advisory implantable cardioverter defibrillator leads with a relatively long implant duration

“…Several studies [3][4][5][6][7] concerning the extraction of advisory ICD leads have been published but the implant duration of the leads are relatively short (2-4 years). Furthermore, there has been only one case report [8] concerning the management of recalled ICD leads in Japan. The purpose of this study was to estimate the efficacy of the transvenous extraction of advisory ICD leads with a longer implanted duration in Japanese patients.…”