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Riata lead failure with normal electrical lead parameters and normal fluoroscopic appearance
Umashankar Lakshmanadoss1, David Lahoda, Pramod Deshmukh
1Division of Cardiology, Guthrie Clinic, 1, Guthrie Square, Sayre, PA 18840, USA. drlumashankar@gmail.com
Riata defibrillator leads can fail without obvious signs, leading to failed shock delivery. This highlights a critical dilemma in managing these devices, even with new generators and seemingly functional leads.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Safety
Background:
- The Riata lead, an implantable cardioverter-defibrillator (ICD) lead, has known issues with insulation breaches.
- Management guidelines exist for externalized leads but not for asymptomatic cases.
Observation:
- Two patients with Riata leads experienced ICD system failure to deliver shock therapy.
- Lead interrogation suggested "appropriately functioning leads" and a new ICD generator was implanted.
Findings:
- Despite apparent lead and generator function, shock delivery failed in these cases.
- This indicates a potential for occult lead malfunction not detected by standard interrogation.
Implications:
- There is an ongoing clinical dilemma regarding the management of patients with Riata leads without manifested failure.
- Further investigation is needed to identify reliable methods for detecting subclinical Riata lead dysfunction.
- This may necessitate revised protocols for monitoring patients with these specific ICD leads.
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