Why and When ICD Leads Are Extracted: Does the ICD Lead Model Influence Lead Survival?

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Analysis

Background:

• Limited data exists on implantable cardioverter-defibrillator (ICD) lead longevity.
• Understanding ICD lead failure modes and model-specific lifespans is crucial for patient care.

Purpose of the Study:

• To compare the survival duration of different ICD lead models.
• To identify the primary reasons for ICD lead extraction.

Main Methods:

• Analysis of 3929 transvenous lead extractions (TLEs), including 1068 ICD lead extractions.
• Comparison of lead survival times and failure causes across various ICD lead models.

Main Results:

• The median ICD lead survival was 61 months, three years shorter than pacemaker (PM) leads.
• Common extraction reasons included infection (35.6%), mechanical damage (33.6%), and dysfunction (20.8%).
• Older, thicker ICD lead models (e.g., Sprint, Ventritex, Kainox) demonstrated significantly longer survival (nearly double) compared to thinner, modern leads (e.g., Riata, Sprint Fidelis).

Conclusions:

• ICD lead survival is notably shorter than PM leads.
• Infection and mechanical damage are the leading causes of ICD lead failure.
• Despite design advancements, the overall lifespan of ICD leads has not significantly improved, with older models outperforming newer ones in durability.