Conflict of Interest: Consultancy Biotronik.
Differential Lead Component Pulling as a Possible Mechanism of Inside-Out Abrasion and Conductor Cable Externalization
Article first published online: 7 JUN 2013
©2013, The Author. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 9, pages 1072–1089, September 2013
How to Cite
LAU, E. W. (2013), Differential Lead Component Pulling as a Possible Mechanism of Inside-Out Abrasion and Conductor Cable Externalization. Pacing and Clinical Electrophysiology, 36: 1072–1089. doi: 10.1111/pace.12185
- Issue published online: 3 SEP 2013
- Article first published online: 7 JUN 2013
- Manuscript Accepted: 23 APR 2013
- Manuscript Revised: 1 APR 2013
- Manuscript Received: 25 FEB 2013
- conductor cable externalization;
- inside-out abrasion;
- differential lead component pulling;
Conductor cable externalization with protrusion (CCE*) is highly prevalent among the Riata 8F and ST 7F defibrillation (DF) leads and infrequently present in the QuickSite and the QuickFlex coronary sinus (CS) leads (St. Jude Medical, Sylmar, CA, USA). A model for CCE* based on differential lead component pulling and conjugate extension with reciprocal compression-bending was developed. Extension of a proximal lead body segment by pectoral or cardiac movements causes reciprocal compression-bending of a distal lead body segment mediated by inextensible conductor cables running down a lead body fixed at various points by fibrous adhesions. The “sawing” action of these cables under tension causes inside-out abrasion of insulation leading to CCE*.
DF leads from different manufacturers and the QuickFlex and QuickFlex μ CS leads were subjected to simulated differential pulling.
Restitution from differential pulling followed three patterns: complete, partial without escalation, and incomplete with escalation. Only the last pattern (only shown by the Riata 8F and ST 7F leads) was associated with an increased risk to CCE*. For CS leads, deformation concentrated on the more flexible segment when the lead body did not have a uniform construction.
The Durata, Riata ST Optim, QuickFlex μ, and Quartet leads should be relatively immune to CCE*. The Durata leads are extremely resistant to longitudinal deformation and probably cause mediastinal displacement rather than differential pulling in response to pectoral movements in vivo. Implantation techniques and lead designs can be used to minimize the risk of CCE*. A bench test for CCE* can be constructed.