Published Online
on May 19, 2008

A more recent version of this article appeared on May 27, 2008

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Submitted on September 17, 2007
Accepted on March 4, 2008

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, and 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.).

^* To whom correspondence should be addressed. E-mail: csticherling{at}uhbs.ch.

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.

Key words: defibrillation • defibrillators, implantable • electrical stimulation • heart arrest • pacing

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