title: Two different therapeutic strategies in ICD lead defects: additional combined lead versus replacement of the lead.
abstract: OBJECTIVE
  Implantation of an additional HV-P/S lead versus extraction of the defective HV-P/S lead and implantation of a new one is one possible therapeutic approach in cases of a defective high-voltage pace/sense lead (HV-P/S). No information is available on potential differences in clinical outcome in these different approaches.
  
  
  METHODS
  Between January 2000 and February 2006, 86 patients with HV-P/S lead defect received either an additional transvenous HV-P/S lead (n = 33, group 1) or the HV-P/S lead was replaced (n = 53, group 2). The duration of the initially implanted leads was significantly different in the two groups (7.4 +/- 2.9; group 1 and 4.1 +/- 3.4 years; group 2). The outcome of these two groups of patients was retrospectively analyzed.
  
  
  RESULTS
  Seventy-three patients [85%] survived until the end of follow-up of 29 +/- 15 (group 1) and 33 +/- 21 (group 2) months (P = ns), respectively. Thirteen patients died: six in group 1 and seven in group 2 (P = ns). Fourteen patients experienced perioperative complications (group 1: six; group 2: eight; P = ns). ICD system-related complications occurred in 22 patients (group 1: seven; group two: 15; P = ns). The event-free cumulative survival of patients with additional and replaced HV-P/S lead for postoperative events (including death) after 1, 2, and 3 years was 82%, 70%, 70%, and 86%, 81%, 66%, respectively (P = 0.93).
  
  
  CONCLUSIONS
  Implantation of an additional HV-P/S lead or replacement of the HV-P/S lead in case of HV-P/S lead failure is statistically not different concerning mortality and morbidity. There are no predictors for further lead defects. Implantation of an additional HV-P/S lead should not be recommended in young patients or patients with greater likelihood of living many years. Predictors for death were an age over 70 years and renal insufficiency.
authors.affiliation: Department of Cardiology and Angiology, University Hospital of Münster, Germany.
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: Matthias
authors.initials: M
authors.lastname: Paul
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Rainer
authors.initials: R
authors.lastname: Gradaus
mesh_terms: D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome