Transvenous lead performance of implantable cardioverter‐defibrillators and pacemakers

Abstract

Background After the reports of recalled leads, several technological improvements have been introduced and the durability of implantable cardioverter defibrillator (ICD) leads has improved. The incidence of lead failures is now less than in the previous studies. However, there are few reports that have shown the long‐term durability of ICD leads as compared to pacemaker (PM) leads. This study analyzed the medium to long‐term performance of transvenous ICD leads as compared to PM leads. Methods We retrospectively studied 1227 cases from April 2007 to December 2017 who underwent an initial transvenous ICD or PM implantation. The number of lead failures and patient background characteristics were analyzed. Results During a median 3–3.5 years follow up period, 1 (0.3%) ICD lead and 18 (2.4%) PM leads failed. The incidence of lead failures was significantly higher in the PM group than ICD group (p = .019). Males were associated with a higher incidence of lead failures in the PM group. Conclusion Since the era of recalled ICD leads, the durability of ICD leads has remarkably improved and the incidence of lead failures with non‐recalled ICD leads has been less than that for PM leads.

Transvenous Lead Extraction in Adult Patient with Leads Implanted in Childhood-Is That the Same Procedure as in Other Adult Patients?

“…The problem of prophylactic extraction of still functioning, but old, or very old, leads remains unsolved. During the past three decades, it has been demonstrated that the risk of lead removal doubles every three years and that lead durability is limited (longer for PM and shorter for ICD leads) [ 36 , 37 , 38 ]. There is still an open question about which strategy is better: prophylactic lead replacement after the end of the growth period or waiting until occurs in any old leads.…”

The subcutaneous implantable cardioverter-defibrillator should be reserved for niche indications

“…Short- and medium-term follow-up studies since the recalls have shown improved survival of defibrillation leads. 35 , 36 In comparison, the first-generation S-ICD leads underwent a U.S. Food & Drug Administration class I recall due to unexpected lead fracture, with an estimated 0.2% annual estimated failure rate. One meta-analysis showed that first-generation S-ICD leads are no more durable than contemporary TV-ICD leads.…”

“…One meta-analysis showed that first-generation S-ICD leads are no more durable than contemporary TV-ICD leads. 35 , 37…”

Venous thoracic outlet syndrome, as a pitfall for cardiac implantable electronic device implantations

“…The incidence of lead fractures is reported to be 0.3%-2.4%. 1 There are several risks of lead fractures, such as frequent upper extremity movements or external injury. Venous thoracic outlet syndrome (TOS) is rare but can also become the cause of external lead stress.…”