Rates and severity of perforation from implantable cardioverter-defibrillator leads: a 4-year study.
BACKGROUND
Although recent case reports and one small single-year observational study report a substantially increased rate of perforation with the St. Jude Riata series defibrillator lead, these results have not been externally validated.


RESULTS
From 2004 to 2007, 593 implantable cardioverter-defibrillator (ICD) implants were performed by six faculty and 13 fellows at four University of California, San Francisco, CA, USA and affiliate hospitals. An electronic medical records system was systematically searched to identify clinically significant cases of ICD lead dislodgment or perforation. Of 307 (56%) St. Jude leads (all Riata series 6.3- and 7.3-French leads), 188 (29%) Medtronic leads (including 99 Sprint Fidelis 6.6 French leads), and 98 (15%) Guidant/Boston Scientific leads, there were three perforations in 593 cases (0.51%). One perforation occurred with a Medtronic Sprint Fidelis 6949 lead (0.53%), and two with a St. Jude Riata 1581 lead (0.65%). There were no statistically significant differences in perforation or dislodgement rates between manufacturers or lead models (p = NS for all). In both cases of perforation with the St. Jude Riata leads, the lead tip perforated through the pericardium into the pleural space.


CONCLUSIONS
In our 4-year series of ICD implants, perforation and dislodgement rates were low, similar across all lead makes and models, and well below published and accepted complication rates. Our findings contradict previously-reported higher rates of perforation with the Riata lead. Registry and product performance reports should also classify complications by severity and outcome to provide a more complete assessment of product safety.
Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, Palo Alto VA Medical Center, 3801 Miranda Ave, Cardiology E2-426, Palo Alto, CA 94304-5588, USA. mintu.turakhia@gmail.com
Mintu
M
Turakhia
Megha
M
Prasad
Jeffrey
J
Olgin
Nitish
N
Badhwar
Zian H
ZH
Tseng
Randall
R
Lee
Gregory M
GM
Marcus
Byron K
BK
Lee
D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000453:epidemiology*