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Mar PL, Tsai C, Golemi L, Bedi R, Khan A, Kabra R, Atkins D, Bhakta D, Lakkireddy D, Gopinathannair R. Poorer outcomes associated with more invasive lead management strategies for Abbott Riata ® leads: a large, multicenter experience. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01673-y. [PMID: 37882994 DOI: 10.1007/s10840-023-01673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Over 100,000 Abbott Riata® were implanted in the United States before they were recalled in 2010. There are still a significant number of Abbott Riata® leads in use, and it is unclear how these leads should be managed at the time of generator change or lead malfunction. Although data comparing both Sprint Fidelis® and Abbott Riata® leads in this setting is available, there are no multicenter comparative studies of outcomes for various lead management strategies, including lead extraction (LE), lead abandonment/revision (LA), and generator change (GC) only at the time of device at elective replacement interval (ERI) for Abbott Riata® leads. METHODS A retrospective, multicenter study was undertaken to compare short-term outcomes (major complications-MC, death, extended or re-hospitalizations within 60 days-RH, lead malfunction-LM) and total outcomes (short-term outcomes & lead malfunction during follow-up) of patients with Riata® leads undergoing LE, LA, or GC. RESULTS 152 patients (65 ± 13 years, 68% male) were followed for a mean 33 ± 30 months following intervention. Out of 166 procedures, 13 patients underwent LE, 16 patients underwent LA, and 137 patients underwent GC. There was 1 major complication in each group, yielding an event rate of 7.7% for LE, 6.3% for LA, and 0.7% for GC cohorts. There were significantly more short-term and total adverse outcomes in the group of patients getting LE and LA versus GC only (38.5% & 31.3% vs 7.3%, P < 0.001). Total Riata® lead dwell time follow-up was 17,067 months. A total of 3 Riata® lead malfunctions were noted during long-term follow-up. Inappropriate shocks were similar between LE 7.7% (1/13), LA 6.3% (1/16). and GC 11.0% (4/136); P = 0.57. CONCLUSIONS There were more short-term and total adverse outcomes in more invasive management strategies (LE and LA) versus GC alone. The failure rate of Riata® leads was substantially lower compared to previous reports. Therefore, we recommend only performing battery exchange when a device with an active Riata® lead is at ERI, unless there is malfunction of the Riata® lead noted on testing. There were significantly more short-term adverse outcomes in the lead extraction (5/13) and lead abandonment/revision (5/16) groups than the generator only (8/137) group (P < 0.001). GIB - Gastrointestinal bleed, CHF - congestive heart failure, NSTEMI - non-ST elevation MI.
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Affiliation(s)
- Philip L Mar
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Christina Tsai
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Lolita Golemi
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Rohil Bedi
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Ali Khan
- Division of Cardiology, St. Louis University, St. Louis, MO, USA
| | - Rajesh Kabra
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA
| | - Donita Atkins
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA
| | - Deepak Bhakta
- Division of Cardiology, Indiana University, Indianapolis, IN, USA
| | - Dhanunjaya Lakkireddy
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA
| | - Rakesh Gopinathannair
- Cardiac Electrophysiology Laboratories, Kansas City Heart Rhythm Institute, University of Missouri-Columbia, 5100 W 110Th St., Ste 200, Overland Park, KS, 66211, USA.
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Philippon F, Domain G, Sarrazin JF, Nault I, O’Hara G, Champagne J, Steinberg C. Evolution of Devices to Prevent Sudden Cardiac Death: Contemporary Clinical Impacts. Can J Cardiol 2022; 38:515-525. [DOI: 10.1016/j.cjca.2022.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 12/12/2022] Open
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Zeitler EP, Wang Y, Pokorney SD, Curtis J, Prutkin JM. Comparative outcomes of Riata and Fidelis lead management strategies: Results from the NCDR-ICD Registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1897-1906. [PMID: 34520564 DOI: 10.1111/pace.14361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/13/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Medtronic Sprint Fidelis® and Abbott Riata®/Riata ST® leads are at risk of failure and are subject to FDA recall. Comparative risks of various lead management strategies during elective generator change in a multi-center population are unknown. We aim to describe patients with functional, recalled ICD leads undergoing elective generator replacement and report outcomes according to lead management strategies. METHODS Using data from the NCDR ICD Registry, patients with a functioning Riata® or Fidelis® lead undergoing generator replacement are described according to lead management: reuse, abandon/replace, and extract/replace. Adjusted rates of death and pre-discharge complications are reported. RESULTS There were 13,144 generator replacement procedures involving a functioning, non-infected Riata® or Fidelis® lead (extraction n = 414, abandonment n = 427). Extraction patients were younger (mean 58 vs. 67 years) with fewer comorbidities than the reuse group. Maximum lead dwell time was similar between groups with average 94, 90, and 99 months in the extraction, abandonment, and reuse groups, respectively. In-hospital complications or mortality were more common in the extraction group (10.14%, 4.35%) compared with abandonment (1.64%, 0.47%) and reuse (0.22%, 0.07%). Compared with reuse, the adjusted odds of death or pre-discharge complication were significantly higher in the extraction group (OR 7.77 95% CI 2.42-24.95, p < .001) but not the abandonment group (OR 1.70 95% CI 0.52-5.61, p = .38). CONCLUSIONS In this real-world population, extraction of functional recalled ICD leads was associated with significant risk of in-hospital mortality and complications. Additional work is needed to clarify whether longer term outcomes balance these peri-procedural risks.
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Affiliation(s)
- Emily P Zeitler
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Yongfei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Sean D Pokorney
- Duke University Hospital, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jeptha Curtis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Jordan M Prutkin
- Division of Cardiology, Section of Electrophysiology, University of Washington, Seattle, Washington, USA
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