title: Effects of electrocautery on transvenous lead insulation materials.
abstract: BACKGROUND
  Insulation defects are a leading cause of transvenous lead failure. The purpose of this study was to determine the effects of electrocautery on transvenous lead insulation materials.
  
  
  METHODS
  A preparation was done to simulate dissection of a transvenous lead from tissues. Radiofrequency energy was delivered using a standard cautery blade at outputs of 10, 20, and 30 W, for 3 and 6 seconds, using parallel and perpendicular blade orientations on leads with outermost insulations of silicone rubber, polyurethane, and silicone-polyurethane copolymer. Damage to each lead segment was classified after visual and microscopic analysis.
  
  
  RESULTS
  Significant insulation damage occurred to almost all polyurethane leads. Full insulation breaches were observed with 30 W regardless of application duration with a parallel direction and with all power outputs with a perpendicular direction. Thermal insulation damage to copolymer insulation was similar to that of the polyurethane leads. In contrast, there was no thermal damage to silicone leads, regardless of the power output and duration of power delivery. However, mechanical insulation damage was observed to all silicone leads when at least 20 W was applied in a direction perpendicular to the lead.
  
  
  CONCLUSIONS
  Polyurethane (PU55D) and copolymer materials have low thermal stability and are highly susceptible to thermal damage during cautery. Implanting physicians should be aware of the lead insulation materials being used during implant procedures and their properties. The use of direct contact cautery on transvenous leads should be minimized to avoid damage to the lead, especially on leads with polyurethane or copolymer outer insulations.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA.
authors.forename: Kiam-Khiang
authors.initials: KK
authors.lastname: Lim
authors.forename: Shantanu
authors.initials: S
authors.lastname: Reddy
authors.forename: Shrojal
authors.initials: S
authors.lastname: Desai
authors.forename: Matthew
authors.initials: M
authors.lastname: Smelley
authors.forename: Susan S
authors.initials: SS
authors.lastname: Kim
authors.forename: John F
authors.initials: JF
authors.lastname: Beshai
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lin
authors.forename: Martin C
authors.initials: MC
authors.lastname: Burke
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
mesh_terms: D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004564:Electrocoagulation / Q000009:adverse effects*; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D006358:Hot Temperature; D008422:Materials Testing; D011140:Polyurethanes / Q000737:chemistry*; D012826:Silicone Elastomers / Q000737:chemistry*; D013499:Surface Properties
chemical_list: D011140:Polyurethanes; D012826:Silicone Elastomers