title: Necessity for surgical revision of defibrillator leads implanted long-term: causes and management.
abstract: BACKGROUND
  Defibrillator lead malfunction is a potential long-term complication in patients with an implantable cardioverter-defibrillator (ICD). The aim of this study was to determine the incidence and causes of lead malfunction necessitating surgical revision and to evaluate 2 approaches to treat lead malfunction.
  
  
  RESULTS
  We included 1317 consecutive patients with an ICD implanted at 3 European centers between 1993 and 2004. The types and causes of lead malfunction were recorded. If the integrity of the high-voltage part of the lead could be ascertained, an additional pace/sense lead was implanted. Otherwise, the patients received a new ICD lead. Of the 1317 patients, 38 experienced lead malfunction requiring surgical revision and 315 died during a median follow-up of 6.4 years. At 5 years, the cumulative incidence was 2.5% (95% confidence interval, 1.5 to 3.6). Lead malfunction resulted in inappropriate ICD therapies in 76% of the cases. Implantation of a pace/sense lead was feasible in 63%. Both lead revision strategies were similar with regard to lead malfunction recurrence (P=0.8). However, the cumulative incidence of recurrence was high (20% at 5 years; 95% confidence interval, 1.7 to 37.7).
  
  
  CONCLUSIONS
  ICD lead malfunction necessitating surgical revision becomes a clinically relevant problem in 2.5% of ICD recipients within 5 years. In selected cases, simple implantation of an additional pace/sense lead is feasible. Regardless of the chosen approach, the incidence of recurrent ICD lead-related problems after lead revision is 8-fold higher in this population.
authors.affiliation: Division of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Eckstein
authors.forename: Michael T
authors.initials: MT
authors.lastname: Koller
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
authors.forename: Dietrich
authors.initials: D
authors.lastname: Kalusche
authors.forename: Beat A
authors.initials: BA
authors.lastname: Schaer
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000706:statistics & numerical data; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013610:Tachycardia / Q000453:epidemiology* / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome