Long-Term Survival in Implantable Cardioverter-Defibrillators(ICD) Leads Inserted by the Extrathoracic Introduction Technique

Background: With the expanded indication of the ICD implantation, complications associated with the transvenous defibrillator lead have been recognized more frequently, varying from 2.5 to 15% at 5 years. The major mechanisms of lead failure are chronic excessive pressure stress by the ligature used for lead fixation or subclavian crush syndrome. These lead failures are expected to be reduced by the careful surgical procedures such as the extrathoracic induction technique. We thus assessed the rate and causes of ICD lead defects by using this technique during long-term follow-up. Methods and Results: A total of 254 defibrillator leads for 248 patients from 1990 to 2010 were studied. All leads were inserted by the extrathoracic introduction technique: cutdown (44 leads) or extrathoracic subclavian puncture (210 leads). The average follow-up period was 3.9 years. Overall, 6 leads failed and the detailed causes were insulation defects in two coaxial single lumen leads with polyurethane insulated design, the suspected microdislodge in one, the lead fractures around the anchoring sleeve in two leads,and the conductor fractures in a Sprint Fidelis 6949 lead. The survival rate of ICD leads at 5 years was 97.1%. Conclusion: The survival rate of ICD leads was 97.1% during 5 years by using the extrathoracic introduction technique. This technique might be useful to reduce the defibrillator lead failures.