PERFORMANCE OF IMPLANTABLE DEFIBRILLATOR PACING SENSING LEAD ADAPTERS/

The wide variety of implantable defibrillators (ICDs) available from d ifferent manufacturers and the lack of universal industry standards ha s resulted in the frequent need for lead adapters at time of ICD impla nt or change. We analyzed the performance of 81 consecutive ICD sensin g/pacing lead adapters used between 1988 and 1993. A total of 66 adapt ers was used for new epicardial systems, and 15 adapters served as lea d connectors during ICD generator replacement. Pacing/sensing lead ada pters used were: model LA-201 (n = 28; 34.5%); model 030-308 (n = 26; 32%); model 5866-24 (n = 15; 28.5%); and miscellaneous (n = 12; 15%). After a mean follow-up of 21 +/- 16 months, nine pacing/sensing lead a dapters had documented or strongly suspected failure. Most often pacin g/sensing lead adapters presented clinically as frequent aborted shock s. Actuarial probability of freedom from failure for model LA-201 was 83% at 1 year, and 72% at 2 and 3 years; this was poorer than for the other sensing leads combined (P = 0.01; hazard ratio = 4.92; 95% confi dence intervals = 1.2-20; log-rank test). in conclusion, pacing/sensin g lead adapters are a potential source of ICD system complications. Pe rformance is dissimilar among different models; specifically, model LA -201 may not be safe in the long-term, and patients with this lead ada pter need to be closely monitored.