title: Implantable Cardiac Defibrillator Lead Failure and Management.
abstract: The implantable-cardioverter defibrillator (ICD) lead is the most vulnerable component of the ICD system. Despite advanced engineering design, sophisticated manufacturing techniques, and extensive bench, pre-clinical, and clinical testing, lead failure (LF) remains the Achilles' heel of the ICD system. ICD LF has a broad range of adverse outcomes, ranging from intermittent inappropriate pacing to proarrhythmia leading to patient mortality. ICD LF is often considered in the context of design or construction defects, but is more appropriately considered in the context of the finite service life of a mechanical component placed in chemically stressful environment and subjected to continuous mechanical stresses. This clinical review summarizes LF mechanisms, assessment, and differential diagnosis of LF, including lead diagnostics, recent prominent lead recalls, and management of LF and functioning, but recalled leads. Despite recent advances in lead technology, physicians will likely continue to need to understand how to manage patients with transvenous ICD leads.
authors.affiliation: Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Swerdlow
authors.affiliation: Division of Cardiology, Virgina Commonwealth University (VCU) School of Medicine, Richmond, Virginia.
authors.forename: Gautham
authors.initials: G
authors.lastname: Kalahasty
authors.affiliation: Division of Cardiology, Virgina Commonwealth University (VCU) School of Medicine, Richmond, Virginia. Electronic address: kenneth.ellenbogen@vcuhealth.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects*; D019468:Disease Management; D004868:Equipment Failure; D006333:Heart Failure / Q000628:therapy*; D006801:Humans
keywords: fracture; implantable defibrillator leads; insulation; recall; ventricular fibrillation