title: Increased incidence of subacute lead perforation noted with one implantable cardioverter-defibrillator.
abstract: BACKGROUND
  The rapid evolution of implantable cardioverter-defibrillator (ICD) leads has resulted in thinner active fixation leads. While these advances have made the leads more versatile, new configurations may be associated with unforeseen complications.
  
  
  OBJECTIVE
  The purpose of this study was to determine the incidence of perforation and dislodgement of defibrillator leads in a single center in the year 2005.
  
  
  METHODS
  All patients who underwent percutaneous ICD implantation at the Massachusetts General Hospital using an endocardial right ventricular lead were included in this study. The specific leads analyzed were the Riata (1580/1581 and 1590/1591, St. Jude Medical, St Paul, Minnesota, USA;) and Sprint Fidelis (6949-65, Medtronic, Minneapolis, Minnesota, USA.). Information was collected retrospectively.
  
  
  RESULTS
  A total of 130 Riata leads and 111 Sprint Fidelis leads were implanted at the Massachusetts General Hospital during this time period. A total of five lead perforations occurred in patients implanted with the Riata lead as compared with none with the Sprint Fidelis lead (3.8% vs. 0%, respectively; P <.05). Two of the five patients with perforation required pericardiocentesis for tamponade. Clinical symptoms of perforation developed 1-10 days after implant. Moreover, there were five additional lead revisions in the Riata group, which were likely due to dislodgement and/or microperforation, as compared with none in the Sprint Fidelis group (7.7% vs. 0%, respectively; P <.005).
  
  
  CONCLUSIONS
  In 2005, at one institution, there were significantly more cardiac perforations and lead revisions with the Riata lead as compared with the Sprint Fidelis right ventricular defibrillator lead. Further data are required to determine whether certain lead characteristics are responsible for this observation.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts 02114, USA. sdanik@partners.org <sdanik@partners.org>
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Danik
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
authors.forename: Jagmeet
authors.initials: J
authors.lastname: Singh
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.forename: David
authors.initials: D
authors.lastname: Milan
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Theofanie
authors.initials: T
authors.lastname: Mela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D009202:Cardiomyopathies / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D020519:Pericardiocentesis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome