Key result
A restrained approach to premature replacement of advisory defibrillator leads is appropriate, and abandoning non-functional leads is safer than extraction, which carries substantial risk.
Why the study?
Does proactive replacement or extraction improve outcomes compared to a conservative approach in patients with advisory defibrillator leads?
Does proactive replacement or extraction improve outcomes compared to a conservative approach in patients with advisory defibrillator leads?
In patients with advisory defibrillator leads, premature replacement should be restrained and non-functional leads should be abandoned rather than extracted due to the high risks associated with extraction.
Supports conservative advisory lead management; leaves open need for randomized trials on abandonment versus extraction.
Defibrillator lead advisories stir a lot of emotions, both with patients and physicians, and this may influence lead management. We reviewed the literature for a more evidence-based approach to this issue.From the complications of two of the current advisory leads, the Medtronic Sprint Fidelis and St. Jude Riata leads, and the consequences of possible interventions, we can conclude that a restrained approach to premature replacement is appropriate. It may be opportune to replace the leads during a scheduled generator replacement in case of a higher electrical failure rate, in order to prevent future premature interventions.We found no support to extract non-functional advisory leads. In contrast, extraction is often more demanding than anticipated, and the risk substantially exceeds that of simply abandoning the leads.
No takes yet. Share an insight, caveat, or question.
Bracke et al. (2015) conducted a review in Advisory defibrillator leads. Lead extraction or premature replacement vs. Conservative management (abandoning leads or wait-and-see) was evaluated. A restrained approach to premature replacement of advisory defibrillator leads is appropriate, and abandoning non-functional leads is safer than extraction, which carries substantial risk.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:
More on Cardiac device therapyMore from Netherlands Heart Journal