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

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.

Abstract 13531: Coronary Artery Disease Predicts Venous Occlusion in Patients Undergoing Lead Extraction

Introduction: Pacemaker and ICD lead failure or vascular occlusion can require lead extraction. Predictors of a need for lead extraction due to venous occlusion are not well characterized. Hypothesis: Coronary artery disease (CAD) is an independent predictor of lead extraction due to venous occlusion. Methods: We performed a retrospective study of consecutive patients in a prospectively collected registry at a single center undergoing lead extraction due to either venous occlusion or lead failure from 10/2011 to 02/2020. Patients requiring lead extraction due to infection were excluded. Continuous variables are reported as mean ± standard deviation or total number reported as a percentage (%). Chi square test and logistic regression were used to estimate difference in rates and Odds Ratio. Statistically significant findings were identified with a p valve < 0.05. Results: Of 384 procedures included in the database, 131 patients met inclusion criteria for venous occlusion (17%) or lead failure (83%) (Table 1). Average age of the cohort was 55.1 ± 16.4 years and 51% were female. Baseline ejection fraction was 44.6 ± 15.5% and 19.7% of patients had NYHA class III or IV symptoms. 29.7% had a history of CAD. Average number of leads extracted was 1.3 ± 0.57 compared to 2.1 ± 0.82 leads in situ. Patients with CAD had a statistically significant increased risk for extraction as a result of venous occlusion Odds Ratio of 6.80, 95% CI 2.47-18.6, p = 0.0001. Conclusions: Identification of predictors of venous occlusion and risk stratification of these patients is an important component of procedural planning and shared decision making. CAD is a predictor of venous occlusion in patients undergoing lead extraction and should be assessed as a risk factor for complex lead management decisions. Further study is warranted to identify mechanisms by which this relationship can be used to predict need for extraction due to vascular occlusion.

Pitfalls of the S-ICD therapy: experiences from a large tertiary centre

Aim The subcutaneous ICD (S-ICD) has evolved to a potential first option for many patients who have to be protected from sudden cardiac death. Many trials have underlined a similar performance regarding its effectiveness in relation to transvenous ICDs and have shown the expected benefits concerning infective endocarditis and lead failure. However, there have also been problems due to the peculiarities of the device, such as oversensing and myopotentials. In this study, we present patients from a large tertiary centre suffering from complications with an S-ICD and propose possible solutions. Methods and results All S-ICD patients who experienced complications related to the device (n = 40) of our large-scale single-centre S-ICD registry (n = 351 patients) were included in this study. Baseline characteristics, complications occurring and solutions to these problems were documented over a mean follow-up of 50 months. In most cases (n = 23), patients suffered from oversensing (18 cases with T wave or P wave oversensing, 5 due to myopotentials). Re-programming successfully prevented further oversensing episode in 13/23 patients. In 9 patients, generator or lead-related complications, mostly due to infectious reasons (5/9), occurred. Further problems consisted of ineffective shocks in one patient and need for antibradycardia stimulation in 2 patients and indication for CRT in 2 other patients. In total, the S-ICD had to be extracted in 10 patients. 7 of them received a tv-ICD subsequently, 3 patients refused re-implantation of any ICD. One other patient kept the ICD but had antitachycardic therapy deactivated due to inappropriate shocks for myopotential oversensing. Conclusion The S-ICD is a valuable option for many patients for the prevention of sudden cardiac death. Nonetheless, certain problems are immanent to the S-ICD (limited re-programming options, size of the generator) and should be addressed in future generations of the S-ICD. Graphic abstract