Incidence of ICD lead related complications during long-term follow-up: comparison of epicardial and endocardial electrode systems.

UNLABELLED: The aim of this study was to evaluate the long-term stability of epicardial and endocardial lead systems for third-generation cardioverter defibrillators (ICDs) and to assess the usefulness of diagnostic tools. One hundred forty patients with 61 epicardial (43.6%) and 79 nonthoracotomy systems (56.4%) were followed for 25 +/- 19 months. A total of 18 (12.9%) lead related complications were documented. Complications of epicardial systems were detected in 10 patients (16.4%) during a follow-up time of 36 +/- 8 months: crinkling of patch electrodes in 6 patients (9.8%), insulation breakage of sensing electrodes in 2 patients (3.3%), and adapter defect in 2 patients (3.3%). Eight of the patients (10.1%) with transvenous-subcutaneous systems had lead related complications during a 13 +/- 6 months follow-up: fracture of the subcutaneous patch lead in 2 patients (2.5%), dislodgement of the right ventricular lead in 2 patients (2.5%), dislodgement of the superior vena cava lead in 2 patients (2.5%), insulation breakage of sensing electrodes in 1 patient (1.3%), and connector defect in 1 patient (1.3%). There was no significant difference in the incidence of lead related complications between epicardial and endocardial systems (P > 0.05). Fractures, dislodgements, and crinklings were documented within the first 8 +/- 5 months by regular chest X ray. Defects of insulation, adapter, or connector were detected 22 +/- 10 months after implantation and were associated with delivery of multiple inappropriate ICD therapies. An operative lead revision was indicated for 4 epicardial (6.6%) and 6 endocardial (7.6%) lead systems.

CONCLUSIONS: Endocardial lead systems offer a similar long-term stability as compared to epicardial lead systems. Chest X ray is the most useful tool to detect lead fracture, dislodgment, and patch crinkling. Marker recordings or real-time electrograms have not been helpful in this series to identify patients with suspected lead defects prior to the experience of inappropriate ICD discharges.