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 R J
Department of Cardiology, Medical College of Virginia, Richmond 23298-0053, USA.
Am J Cardiol. 1996 Sep 15;78(6):647-51. doi: 10.1016/s0002-9149(96)00387-6.
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.
重新设计的Endotak导线（CPI，明尼苏达州圣保罗）在接受经静脉植入式心律转复除颤器（ICD）的患者中广泛应用，该导线在单根经静脉导线上结合了经静脉起搏、感知和除颤功能，降低了ICD植入后的发病率并缩短了住院时间。我们描述了来自4个机构的348例连续患者在1990年至1995年间植入ICD时Endotak感知导线相关故障的发生率及处理情况。我们回顾性分析了接受带有Endotak导线的ICD患者的数据库，以了解导线相关感知异常的发生率。在ICD植入后平均15±11个月时，检测到10例（2.8%）导线相关感知异常患者。6例患者在接受不适当电击后检测到感知异常。通过询问设备的数据记录，在7例患者中发现了噪声或过感知。8例患者植入了新的经静脉感知导线，1例患者植入了新的Endotak导线，1例患者将慢性起搏器感知导线转换为感知功能。10例患者中有8例在平均14±8个月的随访期间未再出现感知问题。感知导线故障部位在5例患者中定位在腹直肌下袋，3例患者中定位在锁骨-第一肋骨区域；另外2例患者未确定，推测在锁骨-第一肋骨区域。1例患者出现除颤导线晚期故障。我们得出结论，Endotak感知导线故障不需要植入新的Endotak导线，但可以通过密切随访和植入新的经静脉感知导线来处理。Endotak导线骨折常定位在ICD囊袋处。
