title: Increased rate of subacute lead complications with small-caliber implantable cardioverter-defibrillator leads.
abstract: BACKGROUND
  Increased rates of complications related to the use of small-diameter implantable cardioverter-defibrillator (ICD) leads have been reported. Lead design and engineering aimed at reducing ICD lead diameter may increase associated subacute complications, including cardiac perforation, lead dislodgement, or lead failure.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether lead caliber altered the risk of perforation, lead dislodgement, or lead failure in a single center.
  
  
  METHODS
  All patients with right ventricular (RV) ICD lead implantation at Vanderbilt University and VA-Nashville Medical Center between January 1, 2007, and August 31, 2007, were included in this study. Leads implanted during this period were the Riata 1580, Riata ST 7000 (St. Jude Medical, St. Paul, MN), Sprint Fidelis 6949, and Sprint Quattro 6947 (Medtronic, Minneapolis, MN). Information was collected retrospectively.
  
  
  RESULTS
  A total of 305 ICD leads were implanted (138 small diameter, 167 standard diameter) during the study period. Failure was defined as development of high pacing threshold, marked sensing change, cardiac perforation, or development of extracardiac stimulation. A total of 11 lead failures occurred in the small-diameter lead group, versus one in the standard group. Implantation of a small-diameter lead (Riata 1580, Riata ST 7000, or Sprint Fidelis 6949) was associated with a significant increase in failure rate, 8.0% versus 0.6% (P = .0008) compared with standard-size leads (Sprint Quattro 6947).
  
  
  CONCLUSIONS
  Subacute lead-related complications were more likely with use of small-diameter ICD leads (Riata 1580, Riata ST 7000, Sprint Fidelis 6949) than with with standard-caliber ICD leads (Sprint Quattro 6947).
authors.affiliation: University of Michigan, Cardiovascular Center, Ann Arbor, Michigan 48109, USA. chrellis@med.umich.edu
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ellis
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Rottman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013997:Time Factors