title: Incidence of complications in patients with implantable cardioverter/defibrillator who receive additional transvenous pace/sense leads.
abstract: 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.
authors.affiliation: Department of Cardiology and Angiology, University of Münster, Germany. christian.wollmann@mednet.uni-muenster.de
authors.forename: Christian G
authors.initials: CG
authors.lastname: Wollmann
authors.forename: Dirk
authors.initials: D
authors.lastname: Böcker
authors.forename: Andreas
authors.initials: A
authors.lastname: Löher
authors.forename: Julia
authors.initials: J
authors.lastname: Köbe
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
authors.forename: Günter E
authors.initials: GE
authors.lastname: Breithardt
authors.forename: Rainer
authors.initials: R
authors.lastname: Gradaus
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric