Incidence of Complications in Patients with Implantable Cardioverter/Defibrillator Who Receive Additional Transvenous Pace/Sense Leads

• Published in: Pacing and clinical electrophysiology 2005-08, Vol.28 (8), p.795-800
• Main Authors: WOLLMANN, CHRISTIAN G., BÖCKER, DIRK, LÖHER, ANDREAS, KÖBE, JULIA, SCHELD, HANS H., BREITHARDT, GÜNTER E., GRADAUS, RAINER
• Format: Article
• Language: English
• Subjects: Aged; Chi-Square Distribution; complications; Defibrillators, Implantable; Electrodes, Implanted; Female; Humans; implantable cardioverter defibrillator; Incidence; leads; Male; Middle Aged; Postoperative Complications - epidemiology; Reoperation; Retrospective Studies; Statistics, Nonparametric
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2005.00169.x

Background: Implantation of an additional pace/sense (P/S) lead is commonly used in patients with implantable cardioverter/defibrillators (ICDs) to overcome P/S defects of integrated defibrillation leads (HV‐P/S leads). No information is available about the clinical outcome and the incidence of complications in these patients. Methods: Retrospective analysis was performed in 151 patients (125 male, age 54.9 ± 13.6 years, LVEF 48.1 ± 17.8%, CAD in 86 [57%], DCM in 24 [16%], ARVCM in 11 [7%]) who received an additional P/S lead between 1990 and 2002 (54 patients with abdominal and 97 patients with pectoral ICD system). Statistical analysis was done using Kaplan‐Meier survival curves. Results: The average follow‐up (FU) after implantation of the additional P/S lead was 43 ± 27 months. In total 117 patients [77.5%] remain implanted; 22 patients died due to cardiac‐related reasons. After a FU of 23 ± 23 months, 43 patients [28.5%] experienced lead‐related problems after implantation of the additional P/S lead: oversensing in 23 [53.5%], insulation defect in 3 [7.0%], fracture in 1 [2.3%], system infection in 4 [9.3%], and defect of the HV‐P/S lead in 6 [14.0%] patients. The event‐free cumulative survival of the additional P/S lead after 1, 2, and 5 years was 87.0%, 79.8%, and 59.4%, respectively (for pectoral leads: 89.6%, 82.0%, and 60.0%, respectively). Conclusions: Implantation of an additional P/S lead in case of failure of an HV‐P/S lead is safe. However, it is associated with a substantial rate of complications during FU. Therefore, extraction of damaged defibrillation leads instead of implantation of P/S leads should be favored.