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

Background and Objectives: There is limited knowledge on ICD lead lifespan, the reasons for lead failure, and the influence of lead models. Our aim in this study was to compare the lifetime of individual lead models and the reasons for their extraction. Materials and Methods: We analyzed 3929 transvenous lead extractions (TLEs) (including 1068 ICD lead extractions). Results: The median age of an ICD lead removed (for all causes) was 61 months, three years shorter than that of PM leads. Old models with thick leads survived almost twice as long as thin and modern leads. ICD leads were removed due to infection (35.6%), mechanical damage (33.6%), and dysfunction (including perforation) (20.8%). Riata leads presented higher resistance to mechanical damage compared to Sprint Fidelis and Linox (dwell time medians; 124.0, 47.0 and 70.0 months). However, Durata leads presented higher resistance to mechanical damage compared to Sprint Fidelis and Linox (dwell time medians; 81.0, 68.0 and 70.0 months). Riata leads lasted almost twice as long as Sprint Fidelis. Linox leads lasted as long as theoretically fail-safe Sprint Quatro leads. Conclusions: 1. The median of ICD lead survival was three years shorter than that of PM leads. 2. ICD leads were most commonly removed due to infection, mechanical lead damage, and undamaged lead dysfunction (including perforation). 3. Old models of thick leads (Sprint, Ventritex, and Kainox) survived almost twice as long as thin leads from the transition period (Riata and Sprint Fidelis) and modern leads. Despite advances in the design of ICD leads, their lifetime has not changed significantly.