Increased incidence of subacute lead perforation noted with one implantable cardioverter-defibrillator.
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.
Danik
Stephan B
SB
Cardiac Arrhythmia Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts 02114, USA. sdanik@partners.org <sdanik@partners.org>
Mansour
Moussa
M
Singh
Jagmeet
J
Reddy
Vivek Y
VY
Ellinor
Patrick T
PT
Milan
David
D
Heist
E Kevin
EK
d'Avila
Andre
A
Ruskin
Jeremy N
JN
Mela
Theofanie
T
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