Sensing lead-related complications in patients with transvenous implantable cardioverter-defibrillators

The widespread use of the redesigned Endotak lead (CPI, St. Paul, Minnesota), which combines transvenous pacing, sensing, and defibrillation on a single transvenous lead in patients receiving transvenous implantable cardioverter-defibrillators (ICDs), has reduced morbidity and shortened length of ho...

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Bibliographic Details
Published in:The American journal of cardiology 1996-09, Vol.78 (6), p.647-651
Main Authors: Lawton, J S, Ellenbogen, K A, Wood, M A, Stambler, B S, Herre, J M, Nath, S, Bernstein, R C, DiMarco, J P, Haines, D E, Szentpetery, S, Baker, L D, Damiano, Jr, R J
Format: Article
Language:English
Subjects:
Aged
Cardiac Pacing, Artificial
Cardiovascular disease
Defibrillators, Implantable - adverse effects
Electric Countershock
Equipment Failure
Female
Humans
Incidence
Male
Medical research
Medical technology
Middle Aged
Retrospective Studies
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Description
Summary:The widespread use of the redesigned Endotak lead (CPI, St. Paul, Minnesota), which combines transvenous pacing, sensing, and defibrillation on a single transvenous lead in patients receiving transvenous implantable cardioverter-defibrillators (ICDs), has reduced morbidity and shortened length of hospital stay after ICD implantation. We describe the incidence and management of Endotak sensing lead-related failures in a series of 348 consecutive patients from 4 institutions who underwent implantation between 1990 and 1995. We retrospectively reviewed the databases for patients receiving an ICD with an Endotak lead for the incidence of lead-related sensing abnormalities. Ten patients (2.8%) with lead-related sensing abnormalities were detected at a mean of 15 +/- 11 months after ICD implantation. Sensing abnormalities were detected in 6 patients after they received inappropriate shocks. Noise or oversensing was noted in 7 patients from interrogation of the devices' data logs. Eight patients had a new transvenous sensing lead placed, 1 patient had a new Endotak lead placed, and 1 had a chronic pacemaker sensing lead converted to function as a sensing lead. No further sensing problems were noted in 8 of 10 patients during a mean follow-up of 14 +/- 8 months. The site of the sensing lead failure was localized to the subrectus pocket in 5 patients and to the clavicle-first rib area in 3 patients; it was undetermined and presumed to be in the clavicle-first rib area in the other 2 patients. One patient had late failure of the defibrillation lead. We conclude that Endotak sensing lead failure does not require insertion of a new Endotak lead, but can be managed with close follow-up and insertion of a new transvenous sensing lead. Endotak lead fractures are frequently localized to the ICD pocket.
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(96)00387-6