Long-Term Follow-Up of Standard and Small-Diameter Implantable Cardioverter Leads

Abstract

Background Small-diameter implantable cardioverter-defibrillator ICD leads have been introduced into clinical practice to facilitate the implantation procedure Despite their expected benefits the reliability of these leads has proven to be questionable The main purpose of our study is to investigate the impact of ICD lead diameter 8 F versus 8 F on long-term lead durability Methods Overall 206 consecutive patients implanted with a right ventricular ICD lead in the Electrophysiology and Cardiac Pacing Unit of our department from January 2008 to December 2013 were included in this analysis ICD leads were defined according to their diameter as small 8 F and standard 8 F The small-diameter leads n 106 included Linox Biotronik n 58 and Durata St Jude Medical Abbot n 48 The standard-diameter ICD leads n 100 consisted of Sprint Quattro Medtronic n 64 and Endotak Boston Scientific n 36 Results After a median follow-up of 7 3 years lead failure rate was significantly increased for small-diameter leads compared with standard-diameter leads 6 6 vs 1 P 0 035 No difference in lead survival probability has been observed between Linox and Durata small-diameter leads 93 vs 92 7 P 0 71 The majority of lead failures presented as noise 87 5 without detectable abnormalities on fluoroscopic evaluation Conclusions Our single-centre study showed that both Linox and Durata small-diameter ICD are associated to be more susceptible to a greater risk of lead failure as compared to standard-diameter ICD leads In this perspective a comprehensive vigilance strategy including home monitoring is warranted for early detection of lead failure