Authors D. Erkapic and G. Z. Duray contributed equally to this manuscript.
Insulation Defects of Thin High-Voltage ICD Leads:
An Underestimated Problem?
Article first published online: 1 APR 2011
© 2011 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 22, Issue 9, pages 1018–1022, September 2011
How to Cite
ERKAPIC, D., DURAY, G. Z., BAUERNFEIND, T., DE ROSA, S. and HOHNLOSER, S. H. (2011), Insulation Defects of Thin High-Voltage ICD Leads:. Journal of Cardiovascular Electrophysiology, 22: 1018–1022. doi: 10.1111/j.1540-8167.2011.02055.x
Dr. Hohnloser has served as an investigator and as a consultant to St. Jude Medical; he reports serving as consultant to or on the advisory boards of Sanofi-aventis, Aryx, and Cardiome. Dr. Duray has served as a member of the St. Jude Medical speaker's bureau. Other authors: No disclosures.
- Issue published online: 14 SEP 2011
- Article first published online: 1 APR 2011
- Manuscript received 13 January 2011; Revised manuscript received 2 February 2011; Accepted for publication 8 February 2011.
- insulation defect;
- lead problem;
- Riata lead;
- ventricular tachycardia
Insulation Defects of Thin High-Voltage ICD Leads. Background: Long-term lead failure is a known complication of ICD therapy. The precise incidence and sequelae of insulation defects at the tricuspid level, however, are not well characterized.
Objective: This study determined the risk of lead failure, with particular emphasis on insulation defects at the level of the tricuspid valve, in a large series of consecutive ICD recipients.
Methods: Data from 357 consecutive patients, who had received transvenous 7 and 8 French ICD-leads (St. Jude Medical, Riata family) and were followed at our center, formed the basis of this study.
Results: During a mean follow-up of 42 ± 24 months, 30 of 357 (8%) patients required surgical intervention due to lead failure. For overall lead defects, lead access via the subclavian vein and subpectoral device placement were independent predictors of overall lead failure (OR 3.47, 95% CI 1.38–8.72, P = 0.013 and OR 3.83, 95% CI 1.77–8.27, P = 0.001, respectively). Lead insulation defects at the level of the tricuspid valve accounted for 20% of all lead failures. Diagnosis of this specific insulation defect could only be established by fluoroscopy, while electrical parameters were within normal limits in all of these patients. On univariate but not on multivariate analysis the presence of nonischemic cardiomyopathy was a predictor of this lead complication (OR 8.2, CI 1.5–46.1, P = 0.02).
Conclusion: Insulation defects of 7 and 8 French ICD leads at the tricuspid level represent an important complication of device therapy. Even moderate changes in lead impedance within the normal limits at follow-up should prompt careful fluoroscopic evaluation to avoid spurious shocks. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1018-1022, September 2011)