Letter by Suri and Keller 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.107.720367
ISSN1524-4539
Autores Tópico(s)Cardiac Arrhythmias and Treatments
ResumoHomeCirculationVol. 116, No. 18Letter by Suri and Keller 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/EPUBLetter by Suri and Keller Regarding Article, "Annual Rate of Transvenous Defibrillation Lead Defects in Cardioverter-Defibrillators Over a Period of >10 Years" Ranjit Suri and Seth Keller Ranjit SuriRanjit Suri Cardiac Arrhythmia Center and Cardiac Electrophysiology Laboratory, New York Hospital Queens, Flushing, NY and Seth KellerSeth Keller Cardiac Arrhythmia Center and Cardiac Electrophysiology Laboratory, New York Hospital Queens, Flushing, NY Originally published30 Oct 2007https://doi.org/10.1161/CIRCULATIONAHA.107.720367Circulation. 2007;116:e512To the Editor:The high failure rates of transvenous defibrillation leads in implantable cardioverter-defibrillators reported by Kleemann et al1 are quite disturbing. This article raises many issues about lead design, implantation techniques, and follow-up.First, the electrophysiology community craves leads with small diameters. This preference may have a negative impact on lead durability. Polyurethane, which is used to produce smaller leads, is more likely to degrade prematurely. Kleemann et al make the case for reevaluating the design of smaller leads. Although the poor performance of older leads is concerning, they had a better survival rate than newer models. The authors speculate that "the better survival of the Medtronic 6936 or 6966 is partly a result of the larger diameter."In addition, smaller leads appear to be associated with an increased incidence of perforation.2 Transmission of greater force per unit area and increased torque at the tissue-lead interface may result in more frequent perforation. Yet there seems to be continuing pressure on industry to downsize defibrillator leads. This downsizing may lead to increased complication rates and decreased lead survival.Second, the authors stated that 95% of the leads were implanted via the subclavian vein, an approach that is associated with more lead complications. In light of this study, implanters should strongly consider using either the cephalic3 or axillary approach to limit mechanical stress, especially in patients at higher risk for lead stress. Additionally, a recent communication from a manufacturer4 suggests problems with other small-diameter leads having a higher-than-expected conductor fracture rate. In this case, their preliminary investigation suggests that "variables within the implant procedure may contribute significantly to these fractures."Kleemann et al also show a trend toward a higher rate of lead defects when multiple transvenous leads are implanted. It is therefore imperative that we implant the most appropriate device with the least amount of hardware. Clearly, device selection and implantation technique are critical to lead survival. The "fast-track" approach to train nonelectrophysiologists to implant defibrillators may further compound this problem.5Finally, we believe that the study highlights the need for defibrillation threshold testing during follow-up. Basic interrogations failed to identify one third of the defects. Defibrillation threshold testing would allow measurement of shocking impedance in devices from all manufacturers. Additionally, it may provoke postshock oversensing, a sign of insulation failure. Routine defibrillation threshold testing may allow earlier diagnosis of lead failure and may reduce the incidence of inappropriate shocks.DisclosuresDr Suri has received grant support and speakers' honoraria from St Jude Medical, Medtronic, and Boston Scientific. In addition, he has served as a consultant to St Jude Medical and Medtronic. Dr Keller has received grant support from St Jude Medical, Medtronic, and Boston Scientific.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 Danik SB, Mansour M, Singh J, Reddy VY, Ellinor PT, Milan D, Heist EK, d'Avila A, Ruskin JN, Mela T. Increased incidence of subacute lead perforation noted with one ICD lead. Heart Rhythm. 2007; 4: 439–442.CrossrefMedlineGoogle Scholar3 Roelke M, O'Nunain SS, Osswald S, Garan H, Harthorne JW, Ruskin JN. Subclavian crush syndrome complicating transvenous cardioverter defibrillator systems. Pacing Clin Electrophysiol. 1995; 18: 973–979.CrossrefMedlineGoogle Scholar4 Physician information: Sprint Fidelis leads. Minneapolis, Minn: Medtronic; March 21, 2007.Google Scholar5 Curtis AB, Ellenbogen KA, Hammill SC, Hayes DL, Reynolds DW, Wilber DJ, Cain ME. Clinical competency statement: training pathways for implantation of cardioverter defibrillators and cardiac resynchronization devices. Heart Rhythm. 2004; 1: 371–375.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By PORTERFIELD J, PORTERFIELD L, KUCK K, CORBISIERO R, GREENBERG S, HINDRICKS G, WAZNI O, BEAU S and HERRE J (2010) Clinical Performance of the St. Jude Medical Riata Defibrillation Lead in a Large Patient Population, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2009.01651.x, 21:5, (551-556), Online publication date: 1-May-2010. October 30, 2007Vol 116, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.720367PMID: 17967985 Originally publishedOctober 30, 2007 PDF download Advertisement SubjectsCatheter Ablation and Implantable Cardioverter-DefibrillatorElectrophysiologyPacemaker
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