Lead Thrombi Associated with Externalized Cables on Riata ICD Leads: A Case Series

Authors

  • SANDEEP K. GOYAL M.D.,

    Corresponding author
    • Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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    • Sandeep K. Goyal and Christopher R. Ellis contributed equally to this manuscript and are cofirst authors.

  • CHRISTOPHER R. ELLIS M.D.,

    1. Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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    • Sandeep K. Goyal and Christopher R. Ellis contributed equally to this manuscript and are cofirst authors.

  • JEFFERY N. ROTTMAN M.D.,

    1. Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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  • S. PATRICK WHALEN M.D.

    1. Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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  • Dr. Rottman received a research grant from St. Jude Medical; he serves as an unpaid member of the Spectranetics advisory board. Other authors: No disclosures.

Address for correspondence: Sandeep K. Goyal, M.D., Vanderbilt University Medical Center, 323 Preston Research Building, 2220 Pierce Avenue, Nashville, TN 37232, USA. Fax: +1-888-947-2968; E-mail: sandeep.k.goyal@vanderbilt.edu

Thrombi on Riata ICD Leads

St. Jude Riata family ICD leads are subject to an FDA class I recall due to insulation failure, cable extrusions, and a high rate of electrical failures. We present multiple cases of large intravascular thrombus formation adherent to externalized conductor cables on Riata leads. Our observations highlight a previously unknown risk of large or calcified thrombus formation involving externalized conductors. We suggest that these leads should be screened for thrombi prior to potential lead extraction to determine the safest approach. Serial echocardiography may help detect progressive thrombus formation. The role of systemic anticoagulation for prevention or treatment of these thrombi remains unclear.

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