title: Sensing lead-related complications in patients with transvenous implantable cardioverter-defibrillators.
abstract: 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.
authors.affiliation: Department of Cardiology, Medical College of Virginia, Richmond 23298-0053, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Lawton
authors.forename: K A
authors.initials: KA
authors.lastname: Ellenbogen
authors.forename: M A
authors.initials: MA
authors.lastname: Wood
authors.forename: B S
authors.initials: BS
authors.lastname: Stambler
authors.forename: J M
authors.initials: JM
authors.lastname: Herre
authors.forename: S
authors.initials: S
authors.lastname: Nath
authors.forename: R C
authors.initials: RC
authors.lastname: Bernstein
authors.forename: J P
authors.initials: JP
authors.lastname: DiMarco
authors.forename: D E
authors.initials: DE
authors.lastname: Haines
authors.forename: S
authors.initials: S
authors.lastname: Szentpetery
authors.forename: L D
authors.initials: LD
authors.lastname: Baker
authors.forename: R J
authors.initials: RJ
authors.lastname: Damiano
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies