Endocardial lead systems showed similar long-term stability to epicardial systems, with lead-related complications occurring in 10.1% versus 16.4% of patients, respectively (P > 0.05).
Cohort (n=140)
Do endocardial lead systems have a different incidence of lead-related complications compared to epicardial lead systems in patients with ICDs?
Endocardial lead systems offer similar long-term stability compared to epicardial lead systems, with chest X-ray being the most useful tool to detect structural lead defects.
Absolute Event Rate: 10.1% vs 16.4%
p-value: p=> 0.05
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.
Korte et al. (Wed,) conducted a cohort in Patients with third-generation cardioverter defibrillators (ICDs) (n=140). Endocardial lead systems vs. Epicardial lead systems was evaluated on Incidence of lead related complications (p=> 0.05). Endocardial lead systems showed similar long-term stability to epicardial systems, with lead-related complications occurring in 10.1% versus 16.4% of patients, respectively (P > 0.05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: