High shocking and pacing impedances due to defibrillation lead calcification

Purpose We have reported the calcification of Endotak defibrillation leads that required replacement. The aim of this study was to assess calcified Endotak Reliance leads in the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database and compare them to calcified Sprint Fidelis, Sprint Quattro Secure, Riata, and Durata leads in MAUDE. Methods We searched the MAUDE database from 2008 to 2019 for defibrillation lead calcification using the terms “calcium,” “calcification,” and “calcified”. Included were explanted leads whose manufacturers found calcium on the shocking and/or pacing electrode. Results The MAUDE search identified 113 calcified defibrillation leads that qualified for the study, including 109 Endotak Reliance leads, 1 Sprint Quattro Secure lead, 2 Durata leads, 1 Riata ST lead, and no Sprint Fidelis lead. The sign of calcification was a gradual increase in shocking or pacing impedance. Average implant time was 7.4 ± 3.1 (range: 1.3–16.5) years. Only Endotak Reliance leads had shocking coil calcification (n = 72; 66.0%) and five (6.9%) of these failed defibrillation threshold (DFT) testing. Distal pacing electrode calcification affected 55 (50.4%) Endotak Reliance leads. The four other leads had pacing ring electrode calcification only. Conclusion Endotak Reliance defibrillation leads appear prone to shocking coil and/or distal pacing electrode calcification. High impedances may compromise defibrillation and pacing therapy. Patients who have these leads should be monitored; those exhibiting high shocking impedances should be considered for DFT testing. Lead replacement should be considered for pacemaker-dependent patients whose leads exhibit progressively high impedances.