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Updated: Feb 17, 2026
A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Differences in Approaches and Outcomes of Defibrillator Lead Implants Between High-Volume and Low-Volume Operators:
Zohaib A Shaikh, Jessica A Chung, Daniel J Kersten
1Director of Electrophysiology, NYU Winthrop Hospital, 212 Jericho Turnpike, Mineola, NY 11501 USA. tcohen@nyuwinthrop.org.
Insights
High-volume implantable defibrillator operators had fewer lead failures, even when accounting for recalled leads. Patient mortality was similar between high- and low-volume operators.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Operator experience, measured by implant volume, may influence patient outcomes.
- Implantable defibrillator (ICD) lead failure is a significant concern.
- Understanding the impact of operator volume on ICD lead survival is crucial for patient care.
Purpose of the Study:
- To investigate the association between operator volume and implantable defibrillator lead failure.
- To examine the relationship between operator volume and patient mortality.
- To analyze outcomes at a single large implanting center.
Main Methods:
- Analysis of data from the Pacemaker and Implantable Defibrillator Lead Survival Study (PAIDLESS) from 1996-2011.
- Categorization of operators into high-volume (≥500 implants) and low-volume (<500 implants) groups.
- Statistical comparisons using Fisher's Exact test, Wilcoxon rank-sum test, and Kaplan-Meier analysis.
Main Results:
- High-volume operators (n=4) performed 83% of the 3801 implants.
- Low-volume operators implanted fewer recalled leads and used cephalic vein cutdown more frequently.
- Kaplan-Meier analysis showed shorter time to lead failure in the low-volume group (P=.02); mortality was not significantly different (P=.18).
- Adjusted analysis revealed patients of high-volume operators were 43% less likely to experience lead failure.
Conclusions:
- Higher operator volume is associated with a reduced risk of implantable defibrillator lead failure, even when controlling for lead recall status.
- Operator experience appears to be a significant factor in preventing lead failure.
- No significant difference in patient mortality was observed between high- and low-volume operators.
Objectives:
The purpose of this study was to investigate the relationship between operator volume and implantable defibrillator lead failure and patient mortality at a single large implanting center.
Methods:
This study analyzed the differences between high-volume and low-volume defibrillator implanters in the Pacemaker and Implantable Defibrillator Lead Survival Study ("PAIDLESS") between February 1, 1996 and December 31, 2011 at NYU Winthrop Hospital. "High-volume" was defined as performing ≥500 implants over the study period, while "low-volume" was defined as performing <500 implants. Comparisons between the procedure volume groups were performed using Fisher's Exact test, Wilcoxon rank-sum test, and Kaplan-Meier analysis as appropriate.
Results:
Eight operators participated in the study, four of whom were high-volume operators. Of 3801 patients, a total of 3149 (83%) were operated upon by high-volume operators. Low-volume operators implanted fewer recalled leads (12% vs 42%; P<.001) and more often obtained venous access through the cephalic vein cutdown approach (63% vs 38%; P<.001) than high-volume operators. Kaplan-Meier analysis revealed shorter time to lead failure in the low-volume group (P=.02). Time to mortality was not significantly different between the high-volume and low-volume groups (P=.18). When adjusted for lead recall status, patients of high-volume operators were 43% less likely to experience lead failure compared to patients of low-volume operators.
Conclusions:
High-volume defibrillator implanters selected a higher percentage of recalled leads, but their patients were less likely to encounter lead failure when adjusted for lead recall status compared to low-volume operators.
