Abstract 14872: Sensitivity of Cinefluoroscopy Compared With Visual Inspection of the Extracted Lead for Detection of Conductor Externalization of Riata/Riata St ICD Leads

Background: The Riata/Riata ST implantable cardioverter defibrillator (ICD) lead series (St Jude Medical, Sylmar, CA) is vulnerable to a characteristic insulation failure mechanism which results in conductor externalization (CE). This may be visible on cinefluoroscopy, however the sensitivity of this test is unknown when compared with direct visible inspection of extracted leads. Methods: We retrospectively reviewed the records of patients with Riata leads extracted at our center since 01/01/2011, and compared CE on fluoroscopic imaging before extraction with the visual appearance of the extracted lead ex vivo. Cinefluoroscopy of the Riata lead was performed in three planes: posteroanterior, left and right anterior oblique. CE was defined as a conductor that had breached the outer insulation material and was clearly visible outside the lead body on fluoroscopy. Ex vivo, CE was defined as externalization of the conductor cable(s) visible on inspection of the extracted lead with a corresponding linear insulation defect. Results: Of 424 patients with Riata leads 37(8.7%) patients underwent extraction with a mean implant duration of 6.24 years ±1.9 years. The indication for extraction was infection in 12 (32.4%); 7 (18.9%) for electrical or structural lead failure and other indications in 18 (48.6%). CE was evident on cinefluoroscopy in 8 (21.6%) patients before extraction including 2 (25%) leads extracted for electrical failure. Post extraction, CE was visible in an additional 3 (8.1%) leads including 1 (33%) extracted for electrical failure. Overall sensitivity was 72.7%. Conclusions: Cinefluoroscopy has suboptimal sensitivity for detection of CE in Riata ICD leads. The absence of CE on cinefluoroscopy does not imply that the outer insulation is structurally intact. Our results suggest that routine cinefluoroscopy of Riata/Riata ST leads is of limited utility.

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Long-Term Follow-up of Standard and Small Diameter Implantable Cardioverter Leads

10.37191/mapsci-jccr-2(3)-041 ◽

2021 ◽

Author(s):

Paolo Zappulla

Keyword(s):

Small Diameter ◽

Home Monitoring ◽

Cardiac Pacing ◽

Lead Failure ◽

Jude Medical ◽

Icd Leads ◽

Expected Benefits ◽

The Impact

Background: Small-diameter implantable cardioverter-defibrillator (ICD) leads have been introduced into clinical practice to facilitate the implantation procedure. Despite their expected benefits, the reliability of these leads has proven to be questionable. The main purpose of our study is to investigate the impact of ICD lead diameter (≤8 F versus >8 F) on long-term lead durability. Methods: Overall, 206 consecutive patients implanted with a right ventricular ICD lead in the Electrophysiology and Cardiac Pacing Unit of our department from January 2008 to December 2013 were included in this analysis. ICD leads were defined, according to their diameter, as small (≤8 F) and standard (>8 F).The small-diameter leads (n=106) included Linox (Biotronik; n=58) and Durata (St. Jude Medical/Abbot; n=48). The standard-diameter ICD leads (n=100) consisted of Sprint Quattro (Medtronic; n=64) and Endotak (Boston Scientific; n=36). Results: After a median follow-up of 7.3 years, lead failure rate was significantly increased for small-diameter leads compared with standard-diameter leads (6.6% vs 1%; P=0.035). No difference in lead survival probability has been observed between Linox and Durata small-diameter leads (93% vs 92.7%; P=0.71). The majority of lead failures presented as noise (87.5%), without detectable abnormalities on fluoroscopic evaluation. Conclusion: Our single-centre study showed that both Linox and Durata small-diameter ICD are associated to be more susceptible to a greater risk of lead failure as compared to standard-diameter ICD leads. In this perspective, a comprehensive vigilance strategy including home monitoring is warranted for early detection of lead failure.

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High prevalence of insulation failure with externalized cables in St. Jude Medical Riata family ICD leads: Fluoroscopic grading scale and correlation to extracted leads

Heart Rhythm ◽

10.1016/j.hrthm.2012.03.049 ◽

2012 ◽

Vol 9 (8) ◽

pp. 1218-1224 ◽

Cited By ~ 68

Author(s):

Sunthosh V. Parvathaneni ◽

Christopher R. Ellis ◽

Jeffrey N. Rottman

Keyword(s):

Jude Medical ◽

Insulation Failure ◽

Icd Leads ◽

High Prevalence ◽

Grading Scale

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96-42: Comparison of lead failure rates between DF-1 and DF-4 ICD leads in clinical practice

EP Europace ◽

10.1093/europace/18.suppl_1.i71c ◽

2016 ◽

Vol 18 (suppl_1) ◽

pp. i71-i71

Author(s):

Thomas Kleemann ◽

Florian Nonnenmacher ◽

Kleopatra Kouraki ◽

Margit Strauss ◽

Nicolaus Werner ◽

...

Keyword(s):

Clinical Practice ◽

Failure Rates ◽

Lead Failure ◽

Icd Leads

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Abstract 11945: Indications and Outcomes Following Transvenous Extraction of ICD versus Pacemaker Leads

Circulation ◽

10.1161/circ.132.suppl_3.11945 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Eric W Black-Maier ◽

Sean D Pokorney ◽

Robert K Lewis ◽

Alexander Christian ◽

Ruth A Greenfield ◽

...

Keyword(s):

Adverse Events ◽

Dwell Time ◽

Clinical Success ◽

Lead Extraction ◽

Index Hospitalization ◽

Lead Failure ◽

Icd Leads ◽

Pacemaker Leads ◽

Pacing Lead ◽

Major Adverse Events

Introduction: Percutaneous transvenous lead extraction of cardiovascular implantable electronic devices (CIEDs) is increasingly common. Although ICD leads are widely considered to be more difficult to extract than pacemaker leads, there are few direct comparisons. Methods/Results: Using a cohort of 368 consecutive patients undergoing lead extraction (dwell time >1 year) between 2005-2012, we compared baseline characteristics/outcomes in extractions involving pacing versus ICD leads. We defined major adverse events (MAE) as any events/complications that required procedural intervention, transfusion, or that resulted in death or serious harm during index hospitalization. Median age was 60.6 yrs and 29.6% were women. There were 136 (37%) pacing lead extractions and 232 (63%) ICD lead extractions. Pacing leads had a longer dwell time (6.14 yrs [IQR 1.2-10.9 ] versus 4.4 yrs [IQR 1.1-6.4], p<0.001) and higher median LVEF (55% [IQR 35-55] vs. 30% [IQR 20-40], p<0.001) compared with ICD lead patients. Indications for pacing and ICD lead extractions included sepsis/endocarditis (21.3% vs. 24.6%, p=0.48), pocket infection (40.4% vs. 34.9%, p=0.29), and lead failure (15.4% vs. 38.8%, p<0.001). There were no significant differences between pacing and ICD lead extractions in median fluoroscopy time (5.5 vs. 8.5 minutes, p=0.86) or femoral bailout rate (4.4% vs. 5.2%, p=0.73). There were similar rates of all-cause MAE during index hospitalization (5.1% vs. 5.6%), death (2.2% vs 3.2%) and clinical success (97.0% vs. 97.0%, p=0.55) in pacemaker and ICD extractions, respectively. Conclusions: ICD leads are more commonly extracted relative to pacemaker leads, and this difference is driven by larger numbers of lead failure within ICD leads. Despite much longer dwell times, major adverse events were similar in pacing lead cases compared with ICD extractions.

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Metabolic Determinants of Electrical Failure in Ex-Vivo Canine Model of Cardiac Arrest: Evidence for the Protective Role of Inorganic Pyrophosphate

PLoS ONE ◽

10.1371/journal.pone.0057821 ◽

2013 ◽

Vol 8 (3) ◽

pp. e57821 ◽

Cited By ~ 6

Author(s):

Junko Shibayama ◽

Tyson G. Taylor ◽

Paul W. Venable ◽

Nathaniel L. Rhodes ◽

Ryan B. Gil ◽

...

Keyword(s):

Cardiac Arrest ◽

Ex Vivo ◽

Canine Model ◽

Protective Role ◽

Inorganic Pyrophosphate ◽

Electrical Failure

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Intraluminal catheter plasty. an alternative technique to remove tethered abdominal surgical drains

BJR|case reports ◽

10.1259/bjrcr.20210025 ◽

2021 ◽

pp. 20210025

Author(s):

Virjen Patel ◽

Benedict Thomson ◽

Narayanan Thulasidasan ◽

Athanasios Diamantopoulos

Keyword(s):

Structural Damage ◽

Ex Vivo ◽

Cone Beam Ct ◽

Abdominal Drain ◽

Fluoroscopic Imaging ◽

Conventional Methods ◽

The Wire ◽

Surgical Drain ◽

Minimal Resistance

Objective: Retained surgical drains can lead to significant complications including gastrointestinal fistulae, abscess formation and intestinal obstruction. Today, there is little in the literature describing the role of Interventional Radiology (IR) in assisting the removal of surgical drains. We describe the use of the well-established intraluminal catheter plasty technique, previously used for the removal of adhered central venous catheters, in order to remove a tethered abdominal drain. Methods and materials: A 67-year-old female was referred to the IR department for the removal of a 24 Fr Robinson’s intra abdominal surgical drain that could not be removed by conventional methods, as there was a concern that it was kinked internally. Both fluoroscopy and cone beam CT was performed which identified the drain to be sited within the pelvis with no kinks. A first attempt to remove the drain over a 0.035 stiff wire was unsuccessful due to resistance and patient discomfort. We suspected that this was due to adhesions surrounding the drain. Consequently, a 9 x 40mm angioplasty balloon was used over the wire with serial dilatations along the drain to disrupt the adhesions. Several areas of waisting were identified. The drain was gently withdrawn over the wire with minimal resistance. Ex-vivo inspection of the drain showed no evidence of structural damage and fluoroscopic imaging confirmed no retained fragments. Conclusion: We describe a safe and effective novel technique of intraluminal catheter plasty used to remove a tethered surgical drain following failed conventional methods.

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Comparison of lead failure manifestation of Biotronik Linox with St. Jude Medical Riata and Medtronic Sprint Fidelis lead

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-018-0486-0 ◽

2018 ◽

Vol 54 (2) ◽

pp. 161-170 ◽

Cited By ~ 2

Author(s):

Anna Lam ◽

Stefan Buehler ◽

Eleni Goulouti ◽

Romy Sweda ◽

Andreas Haeberlin ◽

...

Keyword(s):

Lead Failure ◽

Jude Medical ◽

Sprint Fidelis

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Active Surveillance of the Implantable Cardioverter-Defibrillator Registry for Defibrillator Lead Failures

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.119.006105 ◽

2020 ◽

Vol 13 (4) ◽

Cited By ~ 1

Author(s):

Frederic S. Resnic ◽

Arjun Majithia ◽

Sanket S. Dhruva ◽

Henry Ssemaganda ◽

Susan Robbins ◽

...

Keyword(s):

Active Surveillance ◽

Failure Rate ◽

High Energy ◽

Implantable Cardioverter Defibrillators ◽

Lead Failure ◽

Data Registry ◽

Icd Leads ◽

First Time ◽

Cardioverter Defibrillators

Background: Several defibrillator leads have been recalled due to early lead failure leading to significant patient harm. Confirming the safety of contemporary defibrillator leads is essential to optimizing treatment for patients receiving implantable cardioverter-defibrillators (ICDs). We therefore sought to assess the comparative long-term safety of the 4 most commonly implanted ICD leads within the National Cardiovascular Data Registry ICD Registry. Methods and Results: A propensity-matched survival analysis of the ICD Registry was performed evaluating 4 contemporary ICD leads in patients receiving an ICD system for the first time. All patients in the ICD Registry aged ≥18 years who underwent an implant of an ICD between April 1, 2011 and March 31, 2016 were included. Monitoring of safety began with ICD implant and continued up to 5 years. A meaningful difference in ICD failure rate was defined as twice (or more) the lead failure rate observed in the propensity-matched comparator patients. Among the 374 132 patients who received a new ICD implant, no safety alerts were triggered for the primary safety end point of lead failure for any of the high energy leads studied. Estimated rates of freedom from lead failure at 5 years ranged from 97.7% to 98.9% for the 4 high-energy leads of interest. Conclusions: Though limited by incomplete long-term outcomes ascertainment, active surveillance of the ICD Registry suggests that there were no meaningful differences in the rate of ICD high-energy lead survival for the 4 most commonly used high-energy ICD leads.

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Pelatihan Penyambungan Kabel Tegangan Menengah 20 KV

Journal of Approriate Technology for Community Services ◽

10.20885/jattec.vol2.iss1.art2 ◽

2021 ◽

Vol 2 (1) ◽

pp. 8-14

Author(s):

Syafriyudin Abubakar ◽

Keyword(s):

Service Life ◽

Electric Power ◽

Short Circuit ◽

Electrical Energy ◽

Electric Power System ◽

Electricity Sector ◽

Insulation Material ◽

Electrical System ◽

Insulation Failure ◽

The Right

A reliable electric power system is needed in distributing electrical energy to customers, in the process of distributing electrical energy, interference in its distribution cannot be avoided, in general, electrical disturbances occur in underground channels, disturbance areas that are prone to and often occur usually at cable connections (Jointing). On cables that are insulated, the emergence of heat is something that must be considered. The current capacity of a cable is influenced by the characteristics of the cable components. Overheating will damage the insulation material and reduce the service life of the cable. The connection process must use the right and correct equipment and materials, to avoid insulation failure in the connection due to excessive heating on the connection which will result in a short circuit which will result in a shutdown of the electrical system. Increasing the skills of workers in the electricity sector is needed to reduce the risk of failure in the electrical system. Key words: cable jointing, insulation failure, skills

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