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(Circulation. 2008;117:2719-2720.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Necessity for Surgical Revision of Defibrillator Leads Implanted Long-Term: Causes and Management

 
An implantable cardioverter-defibrillator has become standard care for secondary prevention of sudden cardiac death and for primary prevention in patients at high risk for sudden cardiac death. Malfunction of the defibrillator lead is a potential long-term complication in this population. The aim of this study was to determine the incidence and causes of lead malfunction necessitating surgical revision and to evaluate 2 surgical approaches to treat lead malfunction. For this purpose, we analyzed 1317 patients who received an implantable cardioverter-defibrillator between 1994 and 2004. During a mean follow-up of 6.5 years, 38 patients required surgery to solve a lead-related problem. Cumulative lead malfunction incidences were 1.8%, 2.5%, and 4.6% at years 3, 5, and 10 years after implantation. At the same time, mortality without lead malfunction was much higher, with cumulative incidences of 14.5%, 22.8%, and 33.6%. The main reasons for lead malfunction were insulation defects (26%), artifact oversensing (24%), and lead fractures (24%). Lead malfunction resulted in inappropriate implantable cardioverter-defibrillator therapy in 76% of the cases. If the integrity of the high-voltage part of the defibrillator lead could be ascertained, only an additional pace/sense lead could be implanted. Otherwise, a new defibrillator lead was used. However, once a malfunction has occurred, the cumulative incidence of recurrent lead malfunction was 8-fold higher and therefore warrants a closer follow-up. See p 2727.

	Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus

 
Although exercise testing is proven to have prognostic value, studies that examine the relationship between exercise ECG (E-ECG) responses and coronary heart disease (CHD) mortality risk in asymptomatic . . . [Full Text of this Article]

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