Riata lead failure manifests as electrical storm with lead parameters showing unique postural variations: a case...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Riata implantable cardioverter-defibrillator (ICD) leads are associated with a specific mechanical failure mode: conductor externalization (CE).
• This CE can lead to delayed-onset electrical lead failure (ELF), posing a risk to patient safety.
• Understanding the long-term implications of CE in Riata ICD leads is crucial for clinical management.

Observation:

• A case study involving a 60-year-old male with ischemic cardiomyopathy and atrial fibrillation who received a Riata ICD lead.
• During a pulse generator replacement, CE was noted in the ventricular lead, but electrical parameters were initially normal.
• Four years later, the patient experienced multiple inappropriate ICD shocks due to ventricular electrogram noise, linked to postural changes in lead parameters.

Findings:

• The patient's Riata ICD lead exhibited delayed electrical lead failure (ELF) manifesting as ventricular electrogram noise and inappropriate shocks.
• Lead impedance and R-wave amplitude varied significantly with patient posture, indicating an underlying electrical issue.
• Successful resolution was achieved by implanting a new ventricular lead and abandoning the affected Riata lead.

Implications:

• Electrically inert conductor externalization (CE) in Riata ICD leads necessitates vigilant follow-up due to the potential for late electrical lead failure (ELF).
• Analyzing electrograms and monitoring lead parameters, especially with postural changes, is vital for detecting and characterizing electrical dysfunction.
• This case highlights the importance of long-term surveillance for patients with Riata ICD leads experiencing CE.