Two different therapeutic strategies in ICD lead defects: additional combined lead versus replacement of the lead.
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.
Wollmann
Christian G
CG
Department of Cardiology and Angiology, University Hospital of Münster, Germany.
Böcker
Dirk
D
Löher
Andreas
A
Paul
Matthias
M
Scheld
Hans H
HH
Breithardt
Günter
G
Gradaus
Rainer
R
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