Cor Vasa 2004, 45(7):311-318
ICD lead-related complications. Mid-term follow-up of 172 patients with nonthoracotomy implantation
- 1 I. interní-kardioangiologická klinika
- 2 I. chirurgická klinika, Fakultní nemocnice u sv. Anny a Masarykova univerzita, Brno, Česká republika
Aim:
To establish the incidence of ICD lead-related complications, the time of their appearance, and to propose methods for their management.
Methods:
A group of 172 consecutive patients (mean age 59.6 ± 13.2 years, 140 males) with ICDs implanted between May 22, 1994 and July 31, 2003, were assessed. All the leads were transvenous leads; ventricular leads had active fixation in 51 cases, and atrial leads in 39. All (133 single-chamber and 39 dual-chamber) generators were implanted in the pectoral region. The patients were followed till September 30, 2003.
Results:
The total time of following the ICD leads of the 172 patients (including 6 patients with subsequent heart transplantation, 3 patients with ventricular lead replacement, and 27 deceased patients) amounted to 28 ± 23 months. Complications involving the RV lead occurred in 12 cases (7.0%): one case (0.6%) of microdislodgement (with RV lead reposition), high acute and subacute defibrillation threshold (resolved via subsequent subcutaneous implantation of an SQ Array lead), fractured pacing/sensing conductor of RV lead (implantation of ventricular PM lead), defective connector block (a new generator and RV lead were implanted), high chronic pacing threshold (ventricular PM lead implanted), and bacterial endocarditis (thoracotomy extraction of RV lead); and three cases (1.7%) of instrument-related insulation defect (resolved by replacement of the RV lead in two cases and by additional implantation of bipolar ventricular pacemaker lead-ventricular PM lead hereinafter-in one case) low intracardiac R-waves (additional ventricular PM lead implanted) each. There was not a single case of atrial lead-related complication.
Conclusion:
In the group of 172 ICD patients there were, at a mean follow-up time of 28 ± 23 (2-108) months, 12 cases (7.0%) of complications involving the RV lead requiring re-operation. The most serious ones were: (1) insulation defect and/or lead fracture of pacing/sensing conductor or connector malfunction, all of which led to inappropriate shocks in 3 (1.7%) patients, (2) low intracardiac R-waves endangering the patient with no ICD therapy delivery in 3 (1.7%) patients.
Keywords: Implantable cardioverter-defibrillator; ICD; ICD leads; Transvenous ICD leads; ICD lead-related complications
Published: July 1, 2004 Show citation