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[Clinical study on 29 pacemaker and defibrillator lead fractures]
Min Tang1, Ke-ping Chen, Fang-zheng Wang
1Department of Arrhythmia, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Cephalic venotomy is the preferred method for pacemaker and implantable cardioverter-defibrillator (ICD) implantation, showing a lower lead fracture incidence. Regular follow-up aids in early detection and management of lead fractures.
Area of Science:
- Cardiovascular medicine
- Biomedical engineering
- Implantable electronic devices
Context:
- Lead fractures are a significant complication of pacemakers and implantable cardioverter-defibrillators (ICDs).
- Understanding the causes and locations of lead fractures is crucial for improving device longevity and patient outcomes.
- Previous implantation techniques may influence the incidence of lead fractures.
Purpose:
- To analyze the probable causes, locations, and remedies for lead fractures in implanted pacemakers and ICDs.
- To compare the incidence of lead fractures based on different implantation methods.
- To identify optimal strategies for managing lead fractures.
Summary:
- A study of 4698 pacemakers and 161 ICDs revealed a 0.6% lead fracture incidence.
- Subclavian venipuncture had a higher fracture rate (0.9%) than cephalic venotomy (0.4%).
- Fractures commonly occurred at the subclavicular region; cephalic venotomy is recommended as the primary implantation method.
Impact:
- Recommends cephalic venotomy as the preferred implantation technique to reduce lead fracture risk.
- Highlights the importance of regular device follow-up for early detection and management of lead fractures.
- Provides insights into common fracture locations, aiding in surgical planning and lead design.
Objective:
To analyze major probable causes, locations and remedies of lead fractures in implanted pacemaker and implanted cardioverter defibrillator (ICD) .
Methods:
From January 1982 to November 2004, on all the pacemakers and ICDs implanted at this hospital, lead fractures were detected timely by regular telemetric programmed testing, chest radiography and electrocardiography. Appropriate remedial actions were given and follow up visits were done to verify the results.
Results:
Of all the 4698 pacemakers and 161 ICDs, there were 29 lead fractures on 31 leads with an incidence rate of 0.6%. The incidence rate of lead fracture was 0.9% for pacemakers/defibrillators implanted by subclavian venipuncture, while it was 0.4% for pacemakers/defibrillators implanted by cephalic venotomy (P = 0.04). Fracture locations: 22 cases at the sub clavicle, 6 cases in the pacemaker pocket, and 1 case in the right ventricle. Among the 29 cases, 24 were implanted with additional new leads, 3 cases whose atrial leads were fractured were switched from DDD mode to VVI. All the patients were followed up for an average of 5.6 months +/- 16.1 months. In one patient, the lead was removed through thoracotomy due to infection of exposed lead.
Conclusions:
Cephalic venotomy is the first choice for pacemaker and ICD implantation, and the second choice is subclavian venipuncture in the outer part of subclavian vein, which has a higher incidence rate of lead fracture. Most lead fractures are detected at the region of medial subclavian. Regular follow-up can help timely detect fractures, so that the cases can be dealt with properly.
