Can we predict and prevent adverse events related to high-voltage implantable cardioverter defibrillator lead failure?

BACKGROUND

In 2007, great concern arose regarding failure of implantable cardioverter defibrillator (ICD) leads from several manufacturers.

OBJECTIVE

Of this analysis was to evaluate the incidence and predictors of Sprint Fidelis lead failure in order to find the best clinical strategy to prevent lead-related adverse events.

METHODS

Four hundred fourteen patients (357 male, 67 ± 12 years) with ICD equipped with right ventricular Sprint Fidelis leads were followed up in our institution.

RESULTS

Over a median follow-up of 35 months (25th-75th percentile = 27-47 months) and a total follow-up of 1,231 patient-years, lead failures occurred in 40 of 414 (9.7%) patients. The annual rate was 3.2% per patient-year. Thirty-five (87.5%) failures were caused by pacing-sensing connector fracture. The risk of lead fracture was higher in patients younger than 70 years (odds ratio = 2.31; 95% confidence interval = 1.14-4.68, p = 0.02). Among 30 patients with pacing-sensing conductor failure and available device diagnostics for failure alerting, the diagnostic parameter which first responded to lead failure was the sensing integrity counter in 15 of 30 (50%), pacing impedance in 12 of 30 (40%), and non-sustained ventricular tachycardia in 3 of 30 (10%). The median time (25th-75th percentile) between diagnostics alert and lead failure-related adverse events or failure acknowledgment was 2.2 (0.3-13.0) days. Twenty-two patients suffered inappropriate shocks due to lead failure. In 50% of patients, daily monitoring by device diagnostics would have alerted physicians to impending lead failure at least 1 day in advance.

CONCLUSIONS

Automatic algorithms based on device diagnostics may detect impending lead failure in nearly 50% of cases. Remote monitoring may prevent failure-related adverse events.