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Response to Letter Regarding Article, “Annual Rate of Transvenous Defibrillation Lead Defects in Cardioverter-Defibrillators Over a Period of >10 Years”

2007; Lippincott Williams & Wilkins; Volume: 116; Issue: 18 Linguagem: Inglês

10.1161/circulationaha.107.187052

1524-4539

Thomas Kleemann, Torsten Becker, Klaus Doenges, Margit Vater, Jochen Senges, Steffen Schneider, W. Saggau, Udo Weisse, Karlheinz Seidl,

Cardiac Arrhythmias and Treatments

HomeCirculationVol. 116, No. 18Response to Letter Regarding Article, "Annual Rate of Transvenous Defibrillation Lead Defects in Cardioverter-Defibrillators Over a Period of >10 Years" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, "Annual Rate of Transvenous Defibrillation Lead Defects in Cardioverter-Defibrillators Over a Period of >10 Years" Thomas Kleemann, MD, Torsten Becker, MD, Klaus Doenges, MD, Margit Vater, MD, Jochen Senges, MD, FACC, Steffen Schneider, MD, Werner Saggau, MD, Udo Weisse, MD and Karlheinz Seidl, MD, FESC Thomas KleemannThomas Kleemann Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Torsten BeckerTorsten Becker Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Klaus DoengesKlaus Doenges Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Margit VaterMargit Vater Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Jochen SengesJochen Senges Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Steffen SchneiderSteffen Schneider Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Werner SaggauWerner Saggau Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany , Udo WeisseUdo Weisse Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany and Karlheinz SeidlKarlheinz Seidl Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen, Germany Originally published30 Oct 2007https://doi.org/10.1161/CIRCULATIONAHA.107.187052Circulation. 2007;116:e513We are thankful to Drs Suri and Keller for their interest in our study.1 Lead defects can have many causes. Therefore, a multilateral approach is needed to reduce the incidence of lead failure. As stated by Drs Suri and Keller, this includes better lead design, improved implantation techniques, and appropriate choice of device.What is also necessary is a detailed analysis of the better outcome of older leads. This analysis should include lead design, comprising lead diameter and insulation material, and an analysis of the patient's characteristics. Because the indications for implantable cardioverter-defibrillators have been extended in the last few years, the number of younger more active patients with longer life expectancy is increasing continuously. Newer lead models have to overcome the growing demands that these patients place on them. Lead testing standards that correspond better to real life are warranted before a new lead model is introduced.As correctly pointed out by Drs Suri and Keller, routine implantable cardioverter-defibrillator controls failed to identify nearly one third of lead defects, and lead failure was detected only by the presence of inappropriate shocks. Early detection before clinical presentation with inappropriate shocks or sudden death is important. Routine defibrillation threshold testing, looking for shock impedance and postshock oversensing, may allow earlier diagnosis.2 However, it is not clear how many inappropriate shocks would have been prevented by regular defibrillation threshold testing in the present study. In addition, it is not known how often defibrillation threshold testing should be performed. It also should be considered that routine defibrillation threshold testing cannot be performed in all patients because some patients could be at increased risk for stroke resulting from atrial fibrillation and the presence of left atrial thrombus or severe spontaneous echo contrasts.3 Hence, better noninvasive lead surveillance parameters are needed to detect the beginnings of lead failure.DisclosuresNone.1 Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, Saggau W, Weisse U, Seidl K. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation. 2007; 115: 2474–2480.LinkGoogle Scholar2 Ellenbogen KA, Wood MA, Shepard RK, Clemo HF, Vaughn T, Holloman K, Dow M, Leffler J, Abeyratne A, Verness D. Detection and management of an implantable cardioverter defibrillator lead failure: incidence and clinical implications. J Am Coll Cardiol. 2003; 41: 73–80.CrossrefMedlineGoogle Scholar3 Zareba W, Steinberg JS, McNitt S, Daubert JP, Piotrowicz K, Moss AJ, for the MADIT II Investigators. Implantable cardioverter-defibrillator therapy and risk of congestive heart failure or death in MADIT II patients with atrial fibrillation. Heart Rhythm. 2006; 3: 631–637.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails October 30, 2007Vol 116, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.187052 Originally publishedOctober 30, 2007 PDF download Advertisement SubjectsCatheter Ablation and Implantable Cardioverter-Defibrillator