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Progressive decrease in amplitude of intracardiac ventricular electrogram and higher left ventricular ejection

Maciej Kubala¹, Sarah Traullé, Laurent Leborgne

¹Department of Cardiac Arrhythmia, Cardiology Unit, Picardie University Hospital, Boulevard Laennec, 80000 Amiens, France. kubala.maciej@chu-amiens.fr

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology

|February 8, 2013

Summary

Structural abnormalities in Riata implantable cardioverter-defibrillator leads were detected in 33% of patients. Externalized conductors, often preceded by electrical lead dysfunction, were associated with higher left ventricular ejection fraction.

Keywords:

Fluoroscopy Implantable cardioverter-defibrillator Insulation Lead failure Riata lead

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Area of Science:

Cardiology
Biomedical Engineering
Medical Device Analysis

Background:

The Riata family of implantable cardioverter-defibrillator leads has been associated with increased rates of structural abnormalities, including externalized conductors.
Limited information exists regarding the reliability and emergence time of functional or structural issues in these leads.

Purpose of the Study:

To assess the prevalence of externalized conductors in Riata leads.
To determine the time lag for the emergence of these abnormalities.
To identify factors associated with conductor externalization and its relation to lead performance.

Main Methods:

A cohort of 36 patients with small-caliber Riata leads was followed.
Repeated face-profile fluoroscopies were performed every 6 months.
The study assessed the prevalence of conductor externalization and its correlation with electrical parameters and adverse events.

Main Results:

Externalized conductors were identified in 12 (33%) patients after a mean delay of 53 months.
Higher left ventricular ejection fraction (LVEF) and a progressive decrease in ventricular electrogram amplitude were independently associated with fluoroscopic failures.
Electrical lead abnormalities preceded the detection of conductor externalization in 83% of affected patients.

Conclusions:

Repeated fluoroscopies effectively detected conductor externalization in a significant percentage of Riata lead patients.
Externalized conductors were linked to improved LVEF and declining electrogram amplitude.
Electrical lead dysfunction frequently preceded the structural abnormality of externalized conductors.