Failures of epicardial and transvenous leads for implantable cardioverter defibrillators

Mattke, Sören; Müller, D; Markewitz, Andreas; Kaulbach, Hans; Schmöckel, Michael; Dorwarth, Uwe; Hoffmann, Ellen; Steinbeck, Gerhard

doi:10.1016/0002-8703(95)90206-6

Cited by 22 publications

(8 citation statements)

References 12 publications

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“…[3][4][5] Lead fractures alone are less common, 0.9% in the series of Gallik et al 4 Two particular sites of lead fracture were noted, i.e. one at the clavicle, first rib junction, and the other within the generator pocket.…”

Section: Discussionmentioning

confidence: 99%

High voltage lead failure diagnosed at upgrade of single-chamber ICD to dual-chamber ICD with CRT

Kaźmierczak¹,

Rzeuski²,

Peregud‐Pogorzelska³

et al. 2006

EP Europace

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We describe a case of defibrillation lead damage which was detected only during an upgrade procedure from single-chamber ICD to dual-chamber ICD with biventricular pacing. The damage was not detected during routine checks in the ICD clinic. In February 2005, the patient was hospitalized on three occasions due to deterioration of heart failure to NYHA IV. Improvement to NYHA III with an EF ¼ 15% was achieved on last hospitalization with administration of cilazapril, carvedilol, furosemide, and spironolactone. ECG showed regular sinus rhythm, 90 bpm, features of old anterior and inferior myocardial infarction, and QRS duration of 135 ms. Cardiac transplantation was considered. Echocardiographic studies confirmed inter-and intraventricular dyssynchrony and cardiac resynchronization therapy (CRT) was selected. The single-chamber ICD, implanted 6 years before, was explanted. A unipolar left ventricular (LV) lead (Attain OTW, Medtronic Inc., Minneapolis, MN, USA) via percutaneous left subclavian approach was implanted. The lateral cardiac vein was used as the site of LV stimulation. An atrial lead was introduced via the same access and placed in the right atrial appendage (Figure 1). Satisfactory pacing parameters were achieved (pacing threshold ,0.5 V; 0.4 ms for both leads). Pacing threshold and resistance of LV lead were checked only in unipolar configuration. A dual-chamber ICD with CRT function (Insync III Protect, Medtronic) was implanted. During the upgrade procedure, no defibrillation test was performed because the last spontaneous appropriate shock was effective with correct defibrillation impedance and the procedure did not involve the defibrillation lead. KEYWORDSAfter the placement of the new ICD in the pocket, the parameters of all leads were checked. Atrial and right ventricular lead (bipolar pace/sense channel of defibrillation lead) showed pacing threshold and sensing similar to external measurements. The LV lead, however, showed impedance .2500 ohm with no capture. Therefore, the lead was disconnected and again checked by the external analyzer showing pacing threshold to be ,0.5 V; 0.4 ms and impedance 830 ohm. Radiologically, the lead position had not moved in three projections. Our conclusion was that the LV pacing channel in the ICD was faulty. We decided to implant another device (Insync III Protect) which again showed no LV pacing and high impedance (.2500 ohm). Therefore, we checked other LV pacing configurations: LV tip-RV tip, LV tip-RV ring, and LV tip-RV coil. We found that the LV was not paced only with LV tip-RV coil configuration, but this particular configuration was the only one available in the Insync III Protect ICD (apart from LV tip-LV ring for a bipolar LV lead).1 This explained the lack of pacing by the new ICD, but of great importance, it gave evidence of failure of the high voltage lead, necessary for defibrillation. Failure of the defibrillation lead was demonstrated by a low energy (1 J) test synchronized shock. Dissection of the extravenous part of the lead

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Section: Discussionmentioning

confidence: 99%

High voltage lead failure diagnosed at upgrade of single-chamber ICD to dual-chamber ICD with CRT

Kaźmierczak¹,

Rzeuski²,

Peregud‐Pogorzelska³

et al. 2006

EP Europace

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“…16 The mechanics and reliability of pacemaker leads has been studied extensively. 2,9,12,17,19 In contrast, the mechanical in vivo conditions of the pacemaker structure have not received much attention in the past. Therefore, we recently studied the feasibility of a preclinical measurement system for in vivo mechanical loading conditions of implanted pacemakers.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Loadings on Pectoral Pacemaker Implants: Correlation of In-line and Transverse Force of the Pectoralis major

et al. 2010

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Recently we presented a method for the assessment of in vivo forces on pectoral device implants motivated from technological and clinical advancements toward smaller implantable cardiac pacemakers and the altered structural demands arising from the reduced device size. Objective of this study was the investigation of the intra-species proportionality of in-line force and transverse reaction force of the Pectoralis major for the characterization of mechanical in vivo loadings on pectoral implants. Two Chacma baboons (23.9 ± 1.2 kg) received bilaterally one chronic and one acute pectoral sub-muscular instrumented pacemaker (IPM) implant. The Pectoralis major muscle was electrically stimulated and resulting in-line and transverse muscle force were measured. The correlation of in-line force and transverse force of the Pectoralis major was investigated using linear regression analyses. The proportionality of in-line and transverse force of the Pectoralis major was found to be subject-specific (R² = 0.17, p < 0.003). Including morphometric parameters, i.e., length along line of action, width over implant and stress, in the regression analysis provided a strong intra-species correlation between in-line and transverse force (R² = 0.71, p < 10⁻⁷). The novel intra-species correlation provides a tool toward the characterization of mechanical in vivo loading conditions of pectoral device implants.

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“…While IPG and ICD leads have received extensive attention with respect to reliability (Fortescue et al, 2004;Hauser et al, 2007;Kron et al, 2001;Mattke et al, 1995) and in vivo mechanics (Baxter and McCulloch, 2001;Zhang et al, 2003;Zhao et al, 2003), research on the in vivo mechanical loadings of pacemaker housing has not been reported to date. The characterization of mechanical loading conditions of pectoral pacemaker implants may potentially be studied in cadaver tests.…”

Section: Introductionmentioning

confidence: 99%

The in vivo assessment of mechanical loadings on pectoral pacemaker implants

Vaal

Neville

Scherman

et al. 2010

Journal of Biomechanics

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Failures of epicardial and transvenous leads for implantable cardioverter defibrillators

Cited by 22 publications

References 12 publications

High voltage lead failure diagnosed at upgrade of single-chamber ICD to dual-chamber ICD with CRT

High voltage lead failure diagnosed at upgrade of single-chamber ICD to dual-chamber ICD with CRT

Mechanical Loadings on Pectoral Pacemaker Implants: Correlation of In-line and Transverse Force of the Pectoralis major

The in vivo assessment of mechanical loadings on pectoral pacemaker implants

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