title: Lead Integrity Alert Is Useful for Assessment of Performance of Biotronik Linox Leads.
abstract: BACKGROUND
  Medtronic's Lead Integrity Alert (LIA) software algorithm is useful for detecting abnormal parameters across various ICD-lead families. However, its utility in the assessment of the Biotronik Linox™ family of high-voltage (HV) leads is unknown.
  
  
  METHODS
  We conducted a retrospective cohort study to assess the performance of the LIA algorithm to detect abnormalities and lead failure in Linox ICD-leads. All LIA-enabled Medtronic devices connected to an active Linox lead were included. The alerts were adjudicated by 2 blinded electrophysiologists and correlated with clinical data.
  
  
  RESULTS
  Between 2008 and 2012, data from 208 patients with 564 patient-years of follow-up were available for analysis. The median follow-up duration was 32 (IQR 21-41 months). Twenty-one LIA triggers were noted in 20 different patients. The median delay until a positive LIA was 32 months (IQR 21-41 months) postimplant with a 5-year lead survival free from LIA of 76%. Ninety-five percent (19/20) LIA alerts were true lead failures. The most common LIA triggers were short V-V intervals (85%) and nonsustained ventricular tachycardia (85%). Abrupt changes of the ICD-lead impedance occurred in 5/20 triggers. Inappropriate ICD-shocks were strongly associated with a positive LIA (30% vs. 7.4%; P = 0.006). Of the explanted Linox leads 53% had visible abnormalities. The sensitivity, specificity, and positive predictive value for lead failure in the presence of a LIA trigger were 87%, 99.5%, and 95.2%, respectively.
  
  
  CONCLUSIONS
  A positive LIA trigger in Biotronik Linox ICD-leads is highly predictive of lead failure. LIA is useful in ongoing surveillance of lead performance.
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Steinberg
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Padfield
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Edna
authors.initials: E
authors.lastname: Hahn
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Sheila
authors.initials: S
authors.lastname: Flavelle
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McILROY
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Otto
authors.initials: O
authors.lastname: VAN Bremen
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: John A
authors.initials: JA
authors.lastname: Yeung-Lai-Wah
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Kerr
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Deyell
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Stanley K
authors.initials: SK
authors.lastname: Tung
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bennett
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Jamil G
authors.initials: JG
authors.lastname: Bashir
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.affiliation: Heart Rhythm Services, University of British Columbia, British Columbia, Canada.
authors.forename: Santabhanu
authors.initials: S
authors.lastname: Chakrabarti
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004562:Electrocardiography; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure
keywords: ICD-lead, lead integrity alert; Linox; defibrillator; lead failure; shock; sudden death