Document Detail


Do abandoned leads pose risk to implantable cardioverter-defibrillator patients?
MedLine Citation:
PMID:  19121802     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: With the increased number of implantable cardioverter-defibrillator (ICD) recipients and the frequent need for device upgrading, lead malfunction is a concern, but the optimal approach to managing nonfunctioning leads is unknown. OBJECTIVE: The purpose of this study was to determine the rate and characteristics of complications related to abandoned ICD leads. METHODS: Patients with abandoned leads were identified by retrospective review of the Mayo Clinic ICD database from August 1993 to May 2002. We reviewed the medical records to assess long-term follow-up for venous thromboembolic complications, device sensing malfunction, appropriateness of delivered shocks, defibrillation threshold (DFT) values before and after lead abandonment, and subsequent surgical procedures related to devices or leads. RESULTS: We identified 78 ICD patients (81% males; mean age 63 +/- 14 years) with 101 abandoned leads (69 in the right ventricle, 31 in the right atrium or superior vena cava, 1 in the coronary sinus). During a mean follow-up of 3.1 +/- 2.0 years, neither sensing malfunction nor venous thromboembolic complications were detected. DFT values were high in 13 patients (17%), but there was no significant increase in mean DFT values before and after lead abandonment in 43 patients for whom both values were available (16.2 +/- 9.2 J before abandonment vs 14.1 +/- 5.5 J after; P = .24). Fourteen patients (18%) required further ICD-related surgery; none of these operations were attributed to abandoned leads. Five-year rates of appropriate and inappropriate shocks were 25.9% and 20.5%, respectively. CONCLUSION: Abandoning a nonfunctioning lead appears to be safe and does not pose a clinically significant additional risk of future complications.
Authors:
Michael Glikson; Mahmoud Suleiman; David M Luria; Marjorie L Martin; David O Hodge; Win-Kuang Shen; David J Bradley; Thomas M Munger; Robert F Rea; David L Hayes; Stephen C Hammill; Paul A Friedman
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-10-11
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  6     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-05     Completed Date:  2009-04-21     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  65-8     Citation Subset:  IM    
Affiliation:
Sheba Medical Center and Tel Aviv University, Tel Hashomer, Israel.
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MeSH Terms
Descriptor/Qualifier:
Arrhythmias, Cardiac / therapy*
Defibrillators, Implantable / adverse effects*
Electric Countershock / instrumentation*
Endocardium / surgery*
Equipment Design
Equipment Failure
Equipment Safety
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Thromboembolism / etiology,  prevention & control*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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