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(Circulation. 2008;117:2727-2733.)
© 2008 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Necessity for Surgical Revision of Defibrillator Leads Implanted Long-Term

Causes and Management

Jens Eckstein, MD; Michael T. Koller, MD; Markus Zabel, MD; Dietrich Kalusche, MD; Beat A. Schaer, MD; Stefan Osswald, MD; Christian Sticherling, MD

From the Division of Cardiology (J.E., B.A.S., S.O., C.S.) and Basel Institute for Clinical Epidemiology (M.T.K.), University Hospital, Basel, Switzerland; Charité-University Hospital Benjamin Franklin, Berlin, Germany (M.Z.); Division of Cardiology, University of Göttingen, Göttingen, Germany (M.Z.); and Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (D.K.).

Correspondence to Christian Sticherling, MD, FESC, University Hospital Basel, Division of Cardiology, Petersgraben 4, 4031 Basel, Switzerland. E-mail csticherling{at}uhbs.ch

Received September 17, 2007; accepted March 4, 2008.

Background— Defibrillator lead malfunction is a potential long-term complication in patients with an implantable cardioverter-defibrillator (ICD). The aim of this study was to determine the incidence and causes of lead malfunction necessitating surgical revision and to evaluate 2 approaches to treat lead malfunction.

Methods and Results— We included 1317 consecutive patients with an ICD implanted at 3 European centers between 1993 and 2004. The types and causes of lead malfunction were recorded. If the integrity of the high-voltage part of the lead could be ascertained, an additional pace/sense lead was implanted. Otherwise, the patients received a new ICD lead. Of the 1317 patients, 38 experienced lead malfunction requiring surgical revision and 315 died during a median follow-up of 6.4 years. At 5 years, the cumulative incidence was 2.5% (95% confidence interval, 1.5 to 3.6). Lead malfunction resulted in inappropriate ICD therapies in 76% of the cases. Implantation of a pace/sense lead was feasible in 63%. Both lead revision strategies were similar with regard to lead malfunction recurrence (P=0.8). However, the cumulative incidence of recurrence was high (20% at 5 years; 95% confidence interval, 1.7 to 37.7).

Conclusions— ICD lead malfunction necessitating surgical revision becomes a clinically relevant problem in 2.5% of ICD recipients within 5 years. In selected cases, simple implantation of an additional pace/sense lead is feasible. Regardless of the chosen approach, the incidence of recurrent ICD lead-related problems after lead revision is 8-fold higher in this population.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 117: 2719-2720. [Full Text]