Implantable Cardiac Defibrillator Lead Failure and Management

• Published in: Journal of the American College of Cardiology Vol. 67; no. 11; pp. 1358 - 1368
• Main Authors: Swerdlow, Charles D., Kalahasty, Gautham, Ellenbogen, Kenneth A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 22.03.2016; Elsevier Limited
• Subjects: Cables; Cardiology; Cardiovascular; Defibrillators; Defibrillators, Implantable - adverse effects; Disease Management; Electrodes; Equipment Failure; Failure; fracture; Heart Failure - therapy; Heart surgery; Humans; implantable defibrillator leads; insulation; Prevention; recall; Transplants & implants; ventricular fibrillation; EMI; ventricular fibrillation; SVC; FDA; RV; LIA; EGM; ICD; fracture; insulation; VF; implantable defibrillator leads; recall; LF; lead integrity alert; right ventricular; electrogram; implantable cardioverter defibrillator; electromagnetic interference; superior vena cava; lead failure; Food and Drug Administration
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2015.12.067

The implantable-cardioverter defibrillator (ICD) lead is the most vulnerable component of the ICD system. Despite advanced engineering design, sophisticated manufacturing techniques, and extensive bench, pre-clinical, and clinical testing, lead failure (LF) remains the Achilles’ heel of the ICD system. ICD LF has a broad range of adverse outcomes, ranging from intermittent inappropriate pacing to proarrhythmia leading to patient mortality. ICD LF is often considered in the context of design or construction defects, but is more appropriately considered in the context of the finite service life of a mechanical component placed in chemically stressful environment and subjected to continuous mechanical stresses. This clinical review summarizes LF mechanisms, assessment, and differential diagnosis of LF, including lead diagnostics, recent prominent lead recalls, and management of LF and functioning, but recalled leads. Despite recent advances in lead technology, physicians will likely continue to need to understand how to manage patients with transvenous ICD leads.