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ICD lead proarrhythmia cured by lead extraction.

Joseph C Lee1, Laurence M Epstein, Linda L Huffer

  • 1Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.

Heart Rhythm
|March 31, 2009
PubMed
Summary

Implantable cardioverter-defibrillator (ICD) leads can cause chronic ventricular tachycardia (VT) through a mechanical effect. Lead extraction can cure this proarrhythmia, preventing further ICD therapies and interventions.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death.
  • However, observed rates of appropriate ICD therapies sometimes exceed predictions based on mortality rates.

Observation:

  • A novel form of ventricular proarrhythmia linked to the mechanical presence of ICD leads was identified.
  • Four patients presented with recurrent ventricular tachycardia (VT) refractory to standard treatments.

Findings:

  • In all four patients, VT exhibited a QRS morphology similar to ICD pacing, suggesting a lead-related cause.
  • Following lead extraction, patients experienced sustained freedom from VT (17-21 months) or controlled VT storm.
  • This proarrhythmia, unlike early post-implantation ectopy, can be chronic and persistent.

Implications:

  • ICD leads can induce chronic, uncontrollable VT via a mechanical effect, necessitating recognition.
  • Lead extraction offers a curative solution for this specific proarrhythmia.
  • Identifying this complication can prevent unnecessary ICD shocks, antiarrhythmic drug use, and ablation procedures.