FAILURES OF EPICARDIAL AND TRANSVENOUS LEADS FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

Lead failures constitute a major risk for patients with an implantable cardioverter defibrillator (ICD). However, data about the incidence a nd patterns of ICD-iead failures in a larger population are lacking. W e analyzed the short-term and midterm performance of 27 epicardial and 103 nonthoracotomy ICD-lead systems during a follow-up period of 36 /- 21 months and 22 +/- 10 months, respectively (p < 0.05). The failur e rate was 5 (19%) of 27 In the epicardial and 6 (6%) of 103 in the no nthoracotomy group (p < 0.05). The most common symptom was erroneous d etection of ventricular fibrillation from artifact sensing in five pat ients. Two patients had to be resuscitated because of failure to defib rillate. toss of pacing and loss of sensing were seen In two patients. Only two asymptomatic lead fractures could be diagnosed on routine ra diograph. In conclusion, there was a considerable rate of lead failure s, especially in epicardial systems. Longterm studies addressing the l ongevity of ICD leads, mechanisms of their failures, and Improved diag nostic facilities are important to further increase the safety of this therapeutic approach.