SENSING LEAD-RELATED COMPLICATIONS IN PATIENTS WITH TRANSVENOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

The widespread use of the redesigned Endotak(TM) lead (CPI, St. Paul, Minnesota), which combines transvenous pacing, sensing, and defibrilla tion on a single transvenous lead in patients receiving transvenous im plantable cardioverter-defibrillators (ICDs), has reduced morbidity an d shortened length of hospital stay after ICD implantation. We describ e the incidence and management of Endotak sensing lead-related failure s in a series of 348 consecutive patients from 4 institutions who unde rwent implantation between 1990 and 1995. We retrospectively reviewed the databases for patients receiving an ICD with an Endotak lead for t he incidence of lead-related sensing abnormalities. Ten patients (2.8% ) with lead-related sensing abnormalities were detected at a mean of 1 5 +/- 11 months after ICD implantation. Sensing abnormalities were det ected in 6 patients after they received inappropriate shocks. Noise or oversensing was noted in 7 patients from interrogation of the devices ' data logs. Eight patients had a new transvenous sensing lead placed, 1 patient had a new Endotak lead placed, and 1 had a chronic pacemake r sensing lead converted to function as a sensing lead. No further sen sing problems were noted in 8 of 10 patients during a mean follow-vp o f 14 +/- 8 months. The site of the sensing lead failure was localized to the subrectus pocket in 5 patients and to the clavicle-first rib ar ea in 3 patients; it was undetermined and presumed to be in the clavic le-first rib area in the other 2 patients. One patient had late failur e of the defibrillation lead. We conclude that Endotak sensing lead fa ilure does not require insertion of a new Endotak lead, but con be man aged with close follow-up and insertion of a new transvenous sensing l ead. Endotak lead fractures are frequently localized to the ICD pocket .