Occurrence and extraction of implantable cardioverter-defibrillator leads with conductor externalization
Abstract
Background: The increasing number of patients with implantable cardioverter-defibrillators (ICD) contributes to the rising number of patients qualifying for a transvenous lead extraction (TLE) due to infection, vascular or lead failure related indications. The purpose of this study was to perform a retrospective analysis of the occurrence of conductor externalization in TLE patients and to assess the success rate in the extraction of these leads. Methods: TLE procedure was performed between 2012 and 2014 of 428 electrodes in 259 patients. Out of these, 143 (33.4%) leads in 138 (52.9%) patients were ICD leads. The indications for the TLE in ICD patients were: infection in 37 patients, lead failure in 84 patients, and others in 17 patients. Conductor externalization was observed in 8 ICD leads (5.6%) in 8 (5.8%) patients. The mean dwelling time for externalized leads was 87.9 (55 to 132) months compared to 60.1 (3 to 246) months of the remaining 135 ICD leads (p = 0.0329). All externalized leads were successfully and completely extracted using device traction, mechanical telescopic sheaths and/or autorotational cutting sheaths. No complications of lead extraction procedures were observed in 8 patients with externalization. Results: Patients with lead externalization were often in a better New York Heart Association functional class (I or II) compared to those in the rest of the study group (p = 0.0212). Conclusions: Conductor externalization is a rare finding in patients undergoing TLE. This occurs with different manufacturers and lead types. In this complication transvenous lead extraction with the mechanical extraction tools can be safely performed.
Keywords: lead extractiondefibrillation leadsconductor externalization
References
- Buiten MS, van der Heijden AC, Schalij MJ, et al. How adequate are the current methods of lead extraction? A review of the efficiency and safety of transvenous lead extraction methods. Europace. 2015; 17(5): 689–700.
- Maciąg A, Syska P, Przybylski A, et al. The effectiveness of transvenous leads extractions implanted more than 10 years before. Cardiol J. 2014; 21(4): 419–424.
- Chudzik M, Kutarski A, Mitkowski P, et al. Endocardial Lead Extraction in the Polish Registry - clinical practice versus current Heart Rhythm Society consensus. Arch Med Sci. 2014; 10(2): 258–265.
- Parkash R, Tung S, Champagne J, et al. Insight into the mechanism of failure of the Riata lead under advisory. Heart Rhythm. 2015; 12(3): 574–579.
- Lau EW. Differential lead component pulling as a possible mechanism of inside-out abrasion and conductor cable externalization. Pacing Clin Electrophysiol. 2013; 36(9): 1072–1089.
- Abi-Saleh B, Refaat MM, Khoury M, et al. Conductor externalization of the Biotronik Kentrox internal cardioverter-defibrillator lead: the tip of another iceberg? Heart Rhythm. 2014; 11(9): 1648–1650.
- Bogossian H, Mijic D, Frommeyer G, et al. Insulation failure and externalized conductor of a single-coil Kentrox lead: an ongoing story? J Cardiovasc Electrophysiol. 2015; 26(2): 226–227.
- Reichlin T, Kühne M, Sticherling C. Repetitive inappropriate implantable cardioverter-defibrillator shocks due to insulation failure with externalized conductor cables of a Biotronik Linox SD ICD lead. Europace. 2016; 18(5): 686.
- Kodoth VN, Hodkinson EC, Noad RL, et al. Fluoroscopic and electrical assessment of a series of defibrillation leads: prevalence of externalized conductors. Pacing Clin Electrophysiol. 2012; 35(12): 1498–1504.
- Cheung JW, Al-Kazaz M, Thomas G, et al. Mechanisms, predictors, and trends of electrical failure of Riata leads. Heart Rhythm. 2013; 10(10): 1453–1459.
- Shen S, Bhave P, Giedrimas E, et al. Prevalence and predictors of cable extrusion and loss of electrical integrity with the Riata defibrillator lead. J Cardiovasc Electrophysiol. 2012; 23(11): 1207–1212.
- Kubala M, Traullé S, Leborgne L, et al. Progressive decrease in amplitude of intracardiac ventricular electrogram and higher left ventricular ejection fraction are associated with conductors' externalization in Riata leads. Europace. 2013; 15(8): 1198–1204.
- Theuns DA, Elvan A, de Voogt W, et al. Prevalence and presentation of externalized conductors and electrical abnormalities in Riata defibrillator leads after fluoroscopic screening: report from the Netherlands Heart Rhythm Association Device Advisory Committee. Circ Arrhythm Electrophysiol. 2012; 5(6): 1059–1063.
- Mitkowski P, Grabowski M, Kowalski O, et al. [National Consultant in Cardiology Experts' Group Guidelines on dealing with patients implanted with some St. Jude Medical Riata and Riata ST leads]. Kardiol Pol. 2014; 72(6): 576–582.
- Pokorney SD, Zhou Ke, Matchar DB, et al. Optimal management of Riata leads with no known electrical abnormalities or externalization: a decision analysis. J Cardiovasc Electrophysiol. 2015; 26(2): 184–191.
- Shah P, Singh G, Chandra S, et al. Failure to deliver therapy by a Riata Lead with internal wire externalization and normal electrical parameters during routine interrogation. J Cardiovasc Electrophysiol. 2013; 24(1): 94–96.
- Goldstein MA, Badri M, Kocovic D, et al. Electrical failure of an ICD lead due to a presumed insulation defect only diagnosed by a maximum output shock. Pacing Clin Electrophysiol. 2013; 36(9): 1068–1071.
- Moorman LP, Moorman JR, DiMarco JP, et al. Increasing lead burden correlates with externalized cables during systematic fluoroscopic screening of Riata leads. J Interv Card Electrophysiol. 2013; 37(1): 63–68.
- Golzio PG, Manganiello S, Gaita F. Labelled leucocyte scintigraphy in an infected externalized Riata lead. Europace. 2014; 16(10): 1442.
- Kolodzinska K, Kutarski A, Grabowski M, et al. Abrasions of the outer silicone insulation of endocardial leads in their intracardiac part: a new mechanism of lead-dependent endocarditis. Europace. 2012; 14(6): 903–910.
- Grabowski M, Rokicki JK, Gajda S, et al. Sprint Fidelis implantable cardioverter-defibrillators lead patient management and survival: Single center study. Cardiol J. 2017; 24(3): 259–265.
- Bongiorni MG, Di Cori A, Segreti L, et al. Transvenous extraction profile of Riata leads: procedural outcomes and technical complexity of mechanical removal. Heart Rhythm. 2015; 12(3): 580–587.
- Maytin M, Wilkoff BL, Brunner M, et al. Multicenter experience with extraction of the Riata/Riata ST ICD lead. Heart Rhythm. 2014; 11(9): 1613–1618.
- Rubenstein DS, Weston LT, Kneller J, et al. Safe extraction of Riata looped extruding filler cables. J Cardiovasc Electrophysiol. 2013; 24(8): 942–946.