| Transvenous cardioverter defibrillator lead malfunction due to terminal connector damage in pectoral implants. | |
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MedLine Citation:
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PMID: 10642134 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Lead failure places patients with implantable cardioverter defibrillators (ICD) at risk for sudden cardiac death or results in delivery of inappropriate shocks. This study describes a mechanism of lead malfunction occurring at the junction of the terminal ring with the conductor coil of the rate sensing terminal connector in one specific model of a transvenous ICD lead. We detected the problem in a population of 179 patients with a mean age of 61 +/- 10 years and a mean lead implant duration of 16 +/- 11 months. All patients underwent pectoral ICD implantation using a submuscular approach. The implanting physician chose to place the ICD on the left side in 155 patients (87%) and on the right side in 24 patients (13%). Cephalic vein cutdown provided central venous access in 147 patients (82%), and subclavian vein puncture provided access in 32 patients (18%). Follow-up examination detected lead failure in six patients (3.5% over 31 months) due to insulation damage with or without conductor coil fracture at the junction of the terminal ring and conductor coil of the IS-1 rate sense terminal. We detected lead disruption 17 +/- 9 months (range 5-31 months) after implantation. Multiple nonsustained arrhythmia episodes exhibiting nonphysiologic intervals associated with noisy rate sensing electrograms during pocket manipulation led to discovery in three patients. The other three patients presented with inappropriate device discharges confirmed by stored high-energy lead electrograms showing normal rhythm. Pacing lead impedance abnormally dropped in two patients. Impedance remained stable in the other four patients. In conclusion, the generator pocket represents an important site of ICD transvenous lead vulnerability. Lead failure may result from conductor coil and/or insulation disruption at the interface with the rate sensing terminal connector. |
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Authors:
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F Mera; D B DeLurgio; J J Langberg; E A Moss; A R Léon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Pacing and clinical electrophysiology : PACE Volume: 22 ISSN: 0147-8389 ISO Abbreviation: Pacing Clin Electrophysiol Publication Date: 1999 Dec |
Date Detail:
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Created Date: 2000-02-03 Completed Date: 2000-02-03 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7803944 Medline TA: Pacing Clin Electrophysiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1797-801 Citation Subset: IM |
Affiliation:
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Carlyle Fraser Heart Center at Crawford Long Hospital, Emory University School of Medicine, Atlanta, Georgia 30365, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Arm / blood supply Arrhythmias, Cardiac / diagnosis Artifacts Axillary Vein Catheterization, Central Venous / instrumentation Death, Sudden, Cardiac / etiology Defibrillators, Implantable* / adverse effects Electric Countershock / adverse effects Electric Impedance Electrocardiography Equipment Failure Female Follow-Up Studies Humans Male Middle Aged Pectoralis Muscles / surgery Risk Factors Subclavian Vein Surface Properties Venous Cutdown |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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