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François C, De Becker B, De Smet M, Knecht S, Duytschaever M, Tavernier R, le Polain de Waroux JB. Interaction between left bundle branch area pacing lead and defibrillator lead: A case report. HeartRhythm Case Rep 2024; 10:72-75. [PMID: 38264098 PMCID: PMC10801089 DOI: 10.1016/j.hrcr.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Clara François
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | - Maarten De Smet
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | | | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
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Morrison N, Voleti N, Cannizzaro M. A Case of 25 Inappropriate Automatic Implantable Cardioverter Defibrillator Shocks and 22 Episodes of Antitachycardia Pacing. Cureus 2023; 15:e35634. [PMID: 37009346 PMCID: PMC10065352 DOI: 10.7759/cureus.35634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
An implantable cardioverter defibrillator (ICD) can save lives from fatal tachyarrhythmias. In rare cases, these devices can fail or malfunction. We present a case of a patient that suffered from 25 inappropriate shocks and 22 episodes of antitachycardia pacing (ATP), secondary to a probable non-traumatic dual lead fracture. One episode of ATP induced an R-on-T phenomenon, causing monomorphic ventricular tachycardia in the patient. The inappropriately functioning ICD also required two magnets to be placed on the patient's chest in the emergency department to convert the device to an asynchronous mode. An unexpected case of this magnitude and in such a brief timeframe has not been reported in prior ICD studies.
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Zehan IG, Tentea CP, Blendea D. A man in his 60s with dyspnoea. Heart 2021; 107:1782-1846. [PMID: 34706890 DOI: 10.1136/heartjnl-2021-319719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Iulia-Georgiana Zehan
- Cardiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania.,Department of Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Calina Patricia Tentea
- Cardiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania.,Department of Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Blendea
- Cardiology, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania .,Department of Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Wang Y, Guo R, Hu W, Zheng J, Wang Q, Jiang J, Kurpad KKN, Kaula N, Long S, Chen J, Kainz W. Magnetic resonance conditionality of abandoned leads from active implantable medical devices at 1.5 T. Magn Reson Med 2021; 87:394-408. [PMID: 34378816 DOI: 10.1002/mrm.28967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/26/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE During MR scans, abandoned leads from active implantable medical devices (AIMDs) can experience excessive heating at the lead tip, depending on the type of termination applied to the proximal contacts (proximal end treatment). The influence of different proximal end treatments (ie, [1] freely exposed in the tissue, [2] terminated with metal in contact with the tissue, or [3] capped with plastic, and thereby fully insulated, on the RF-induced lead-tip heating) are studied. A technique to ensure that MR Conditional AIMD leads remain MR Conditional even when abandoned is recommended. METHODS Abandoned leads from three MR Conditional AIMDs ([1] a sacral neuromodulation system, [2] a cardiac rhythm management pacemaker system, and [3] a deep brain stimulator system) were investigated in this study. The computational lead models (ie, the transfer functions) for different proximal end treatments were measured and used to assess the in vivo lead-tip heating for four virtual human models (FATS, Duke, Ella, and Billie) and compared with the lead-tip heating of the complete MR Conditional AIMD system. RESULT The average and maximum lead-tip heating for abandoned leads proximally capped with metal is always lower than that from the complete AIMD system. Abandoned leads proximally insulated could lead to an average in vivo temperature rise up to 3.5 times higher than that from the complete AIMD system. CONCLUSION For the three investigated AIMDs under 1.5T MR scanning, our results indicate that RF-induced lead-tip heating of abandoned leads strongly depends on the proximal lead termination. A metallic cap applied to the proximal termination of the tested leads could significantly reduce the RF-induced lead-tip heating.
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Affiliation(s)
- Yu Wang
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Ran Guo
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Wei Hu
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Jianfeng Zheng
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Qingyan Wang
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Jay Jiang
- Axonics Modulation Technologies, Irvine, California, USA
| | | | | | - Stuart Long
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Ji Chen
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
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Kim E, Davogustto G, Huang S, Crossley GH, Montgomery JA. Clinical and radiographic predictors of cardiovascular implantable electronic device lead failure at the time of initial implantation. J Arrhythm 2021; 37:1086-1092. [PMID: 34386136 PMCID: PMC8339104 DOI: 10.1002/joa3.12559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the clinical and radiographic factors associated with lead failure by comparing subjects with lead failure within 10 years of implantation with an implant-year-matched group without lead failure. METHODS A case-control study with 49 subjects who received Cardiac Implantable Electronic Device (CIED) between January 1, 1999 and July 31, 2008 and developed lead failure within 10 years of implantation in a single center. The control group consisted of subjects (n = 54) with normally functioning leads matched one-to-one by implant year. RESULTS Among the failure group, the meantime from implantation to device lead failure was 4.70 ± 2.94 years. Older age at implantation was associated with a lower likelihood of lead failure (Odds Ratio (OR) = 0.28 (75 vs 42 years old), 95% CI 0.12-0.63, P = .002). A larger smallest loop diameter on the chest radiograph was also associated with a lower likelihood of lead failure (OR = 0.51 (31 vs 14 mm), 95% CI 0.27-0.97, P = .04). CIED type (defibrillator vs pacemaker) and Ottawa scores were not significantly associated with lead failure. Among lead-specific parameters, defibrillation lead vs pace-sense lead was associated with lead failure (OR = 3.91, 95% CI 1.95-7.81, P < .001). CONCLUSIONS Younger age, defibrillation leads, and small lead loops are associated with lead failure in CIEDs. Techniques to avoid tight loops in the pocket could potentially reduce the risk of lead failure and bear important implications for the implanting physician.
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Affiliation(s)
- Eun‐jeong Kim
- Department of MedicineDivision of Cardiovascular MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Giovanni Davogustto
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Shi Huang
- Vanderbilt University Medical CenterDepartment of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - George H. Crossley
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Jay A. Montgomery
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTNUSA
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Yao A, Goren T, Samaras T, Kuster N, Kainz W. Radiofrequency-induced heating of broken and abandoned implant leads during magnetic resonance examinations. Magn Reson Med 2021; 86:2156-2164. [PMID: 34080721 PMCID: PMC8362172 DOI: 10.1002/mrm.28836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
Purpose The risks of RF‐induced heating of active implantable medical device (AIMD) leads during MR examinations must be well understood and realistically assessed. In this study, we evaluate the potential additional risks of broken and abandoned (cut) leads. Methods First, we defined a generic AIMD with a metallic implantable pulse generator (IPG) and a 100‐cm long lead containing 1 or 2 wires. Next, we numerically estimated the deposited in vitro lead‐tip power for an intact lead, as well as with wire breaks placed at 10 cm intervals. We studied the effect of the break size (wire gap width), as well as the presence of an intact wire parallel to the broken wire, and experimentally validated the numeric results for the configurations with maximum deposited in vitro lead‐tip power. Finally, we performed a Tier 3 assessment of the deposited in vivo lead‐tip power for the intact and broken lead in 4 high resolution virtual population anatomic models for over 54,000 MR examination scenarios. Results The enhancement of the deposited lead‐tip power for the broken leads, compared to the intact lead, reached 30‐fold in isoelectric exposure, and 16‐fold in realistic clinical exposures. The presence of a nearby intact wire, or even a nearby broken wire, reduced this enhancement factor to <7‐fold over the intact lead. Conclusion Broken and abandoned leads can pose increased risk of RF‐induced lead‐tip heating to patients undergoing MR examinations. The potential enhancement of deposited in vivo lead‐tip power depends on location and type of the wire break, lead design, and clinical routing of the lead, and should be carefully considered when performing risk assessment for MR examinations and MR conditional labeling.
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Affiliation(s)
- Aiping Yao
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Tolga Goren
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niels Kuster
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland.,Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Switzerland
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
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De Maria E, Borghi A, Bonetti L, Fontana PL, Cappelli S. Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm? World J Clin Cases 2017; 5:27-34. [PMID: 28255544 PMCID: PMC5314257 DOI: 10.12998/wjcc.v5.i2.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/27/2016] [Accepted: 11/22/2016] [Indexed: 02/05/2023] Open
Abstract
Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator (ICD) leads. Conductor externalization is a “unique” failure mechanism: Cables externalize through the insulation (“inside-out” abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction (not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a non-prospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries (GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.
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De Maria E, Olaru A, Cappelli S. The entirely subcutaneous defibrillator (s-icd): state of the art and selection of the ideal candidate. Curr Cardiol Rev 2015; 11:180-6. [PMID: 25158682 PMCID: PMC4356726 DOI: 10.2174/1573403x10666140827094126] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 02/02/2023] Open
Abstract
The traditional transvenous defibrillator has been one of the greatest advancement in Cardiology in the last 30 years and has demonstrated to reduce arrhythmic and total mortality in selected patients. However the traditional defibrillator can have a high price to pay in terms of complications, the "weakest link" being the transvenous/endocardial leads. The entirely subcutaneous defibrillator (S-ICD) has recently entered into the clinical scenario and represents a valid alternative to the transvenous device. S-ICD can provide substantial advantages, especially among some subgroups of patients (i.e. after device infection, in young patients and arrhythmogenic syndromes). However, given its characteristics, it is fundamental to choose patients that can benefit the most. In this review we will describe advantages and limitations of the SICD and point-out how to select the "ideal candidate" for the implantation.
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Affiliation(s)
| | | | - Stefano Cappelli
- EP Cath Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari, Carpi (Modena), Zip Code 41012, Italy.
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Nakajima H, Sutton R, Toyoshima T. Is the pace/sense conductor related to a high voltage short circuit in a dual coil ICD system? An experimental study. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Brojmohun A, Lou JY, Zardkoohi O, Funk MC. Protected from Torsades de Pointes? What Psychiatrists Need to Know About Pacemakers and Defibrillators. PSYCHOSOMATICS 2013; 54:407-17. [DOI: 10.1016/j.psym.2013.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/17/2013] [Accepted: 02/19/2013] [Indexed: 10/26/2022]
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De Maria E, Bonetti L, Patrizi G, Scrivener J, Andraghetti A, Di Gregorio F, Montin A, Zuccon G, Cappelli S. Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art. J Interv Card Electrophysiol 2011; 34:105-13. [PMID: 21993598 DOI: 10.1007/s10840-011-9626-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 09/15/2011] [Indexed: 10/16/2022]
Abstract
AIMS Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages. METHODS AND RESULTS A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful. CONCLUSIONS S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.
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Affiliation(s)
- Elia De Maria
- Cardiology Unit, Ramazzini Hospital, Via Molinari, Carpi, Modena, Italy, 41012.
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Langman DA, Finn JP, Ennis DB. Abandoned pacemaker leads are a potential risk for patients undergoing MRI. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1051-3. [PMID: 21797902 DOI: 10.1111/j.1540-8159.2011.03176.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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