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Hauser RG, Swerdlow CD. What electrophysiologists should know about cardiac implantable electronic device recalls. Heart Rhythm 2024:S1547-5271(24)00211-X. [PMID: 38403233 DOI: 10.1016/j.hrthm.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Robert G Hauser
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | - Charles D Swerdlow
- Smidt Heart Institute at Cedars Sinai Medical Center, Los Angeles, California
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Hauser RG, Kapphahn-Bergs M, Casey SA, Witt DR, Sengupta JD. Failure to defibrillate or cardiovert due to premature truncation of biphasic shocks from implantable defibrillators. Heart Rhythm 2024; 21:143-149. [PMID: 37956776 DOI: 10.1016/j.hrthm.2023.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND In 2022 and 2023, Medtronic recalled implantable defibrillators because they may deliver less than full-energy shocks. The 2022 problem truncates the second phase of the waveform (SCP-T2), resulting in ∼32-J shocks, and is mitigated by downloadable software. The 2023 malfunction truncates the first phase of the waveform, resulting in 0- to 12-J shocks due to a glassed feedthrough problem (GFT-T1) that might be avoided by programming B>AX shock polarity. OBJECTIVE The purpose of this study was to assess the consequences of GFT-T1 and SCP-T2 shocks in the Food and Drug Administration's Manufacturers and User Facility Device Experience (MAUDE) database and to estimate the incidences of GFT-T1 and SCP-T2. METHODS We analyzed MAUDE reports supplemented by Medtronic data; lead failures were excluded. The incidences of SCP-T2 and GFT-T1 were estimated using USA volumes for devices with glassed feedthroughs. RESULTS One hundred thirty-two devices delivered truncated shocks: 27 (20.5%) were GFT-T1; 103 (78.0%) were SCP-T2; and 2 (1.5%) truncated both phases (BOTH-T1&2). Of 54 ventricular fibrillation (VF) patients, 21 (38.9%) were not defibrillated by truncated shocks: 8 (38.1%) received GFT-T1 shocks, 12 (57.1%) received SCP-T2 shocks, and 1 received a BOTH-T1&2 shock; 2 patients suffered unrelated deaths; 1 was externally rescued; 1 outcome was unknown; the others were defibrillated by subsequent shocks or terminated spontaneously. The majority of patients (79.1%) shocked for ventricular tachycardia (VT) were converted, primarily (94.1%) by SCP-T2 shocks. Estimated incidences of GFT-T1 and SCP-T2 were 0.0078%-0.0088% and 0.1062%-0.1110%. CONCLUSION GFT-T1 and SCP-T2 shocks can result in failure to terminate VF/VT, but they may be preventable. Although the incidences of these truncated shocks are very low, heightened surveillance is warranted.
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Affiliation(s)
- Robert G Hauser
- Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | - Melanie Kapphahn-Bergs
- Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Susan A Casey
- Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Dawn R Witt
- Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jay D Sengupta
- Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Kramer DB, Hauser RG. Implanting a Recalled Device - Choices for Patients, Physicians, and Public Health. N Engl J Med 2023; 389:1832-1834. [PMID: 37952125 DOI: 10.1056/nejmp2309572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Daniel B Kramer
- From the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School - both in Boston (D.B.K.); and the Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis (R.G.H.)
| | - Robert G Hauser
- From the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School - both in Boston (D.B.K.); and the Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis (R.G.H.)
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Berger JM, Sengupta JD, Bank AJ, Casey SA, Sharkey SW, Stanberry LI, Hauser RG. Post-Shock Asystole in Patients Dying Out of Hospital While Wearing a Cardioverter Defibrillator. JACC Clin Electrophysiol 2023; 9:1333-1339. [PMID: 37558289 DOI: 10.1016/j.jacep.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 12/14/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND The wearable cardioverter-defibrillator (WCD) prevents sudden cardiac death due to ventricular tachycardia (VT) or ventricular fibrillation (VF) but does not pace for post-shock asystole (PS-A) or bradycardia (PS-B;<50 beats/ min). OBJECTIVES The purpose of this study was to assess PS-A and PS-B in patients dying out of hospital (OOH) while wearing a WCD. METHODS The database of the U.S. Food and Drug Administration Manufacturers and User Facility Device Experience (MAUDE) was queried for manufacturers' reports of OOH deaths while patients were wearing a WCD. Excluded were patients who did not receive a shock or were initially shocked for asystole or during resuscitation. RESULTS From January 2017 to March 2022, 313 patients received an initial WCD shock for VF (n = 150), VT (n = 90), and non-VF/VT rhythms (n = 73). PS-A occurred in 204 patients (65.2%), and PS-B occurred in 111 (35.5%); 85 (41.7%) PS-A patients also had PS-B. Most PS-A patients (n = 185; 90.7%) had an initial shocked rhythm of VF or VT, but 19 patients (9.3%) were initially inappropriately shocked for atrial fibrillation/supraventricular tachycardia (n = 7) and idioventricular (n = 8) or sinus (n = 4) rhythm. PS-A occurred after the first WCD shock in 118 (63.8%) and after the first, second, or third shocks in 159 patients (85.9%). Seven patients had post-shock heart block. Eight patients had permanent pacemakers; 1 became nonfunctional after 1 shock, and 7 showed noncapture and/or asystole after 1 to 4 shocks. CONCLUSIONS Post-shock asystole appears to be common in patients who die OOH after being shocked by a WCD for VF or VT. PS-A also occurs after inappropriate WCD shocks for non-VF/VT rhythms. Implanted pacemakers may not prevent PS-A after a WCD shock. WCD backup pacing should be explored.
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Affiliation(s)
- Justin M Berger
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Jay D Sengupta
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Alan J Bank
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Susan A Casey
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Scott W Sharkey
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Larissa I Stanberry
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Robert G Hauser
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Hauser RG. An early look at a new leadless pacemaker. J Cardiovasc Electrophysiol 2023; 34:1472. [PMID: 37232415 DOI: 10.1111/jce.15938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Robert G Hauser
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Berger JM, Sengupta JD, Bank AJ, Casey SA, Witt D, Sharkey SW, Stanberry LI, Hauser RG. Causes and Clinical Consequences of Inappropriate Shocks Experienced by Patients Wearing a Cardioverter-Defibrillator. Heart Rhythm 2023:S1547-5271(23)02101-X. [PMID: 37211148 DOI: 10.1016/j.hrthm.2023.03.1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The LifeVest® wearable cardioverter-defibrillator (WCD) prevents sudden cardiac death in at-risk patients who are not candidates for an implantable defibrillator. The WCD's safety and efficacy may be impacted by inappropriate shocks (IAS). OBJECTIVE Assess causes and clinical consequences of WCD inappropriate shocks in survivors of IAS events. METHODS The FDA Manufacturers and User Facility Device Experience (MAUDE) database was searched for IAS adverse events (AE) that were reported during 2021 and 2022. RESULTS A total of 2,568 IAS-AE were found (average # IAS/event: 1.5±1.9; range: 1-48). IAS were caused by tachycardias (1,255, 48.9%), motion artifacts (840, 32.7%), and oversensing (OS) of low-level electrical signals (473, 18.4%) (p<0.001). Tachycardias included atrial fibrillation (AF; 828,32.2%), supraventricular tachycardia (SVT; 333,13.0%), and non-sustained ventricular tachycardia/fibrillation (NSVT/VF; 87, 3.4%). Activities responsible for motion-induced IAS included riding a motorcycle, lawnmower, or tractor (n=128). IAS induced sustained VT or VF in 19 patients that were subsequently terminated by appropriate WCD shocks.Thirty patients fell and suffered physical injuries. Conscious patients (n=1905) did not use the response buttons to abort shocks (47.9%) or used them improperly (20.2%). IAS resulted in 1,190 emergency room visits or hospitalizations, and 17.3% (421/2440) of patients discontinued the WCD after experiencing IAS, especially multiple IAS. CONCLUSIONS The LifeVest WCD may deliver IAS caused by AF, SVT, NSVT/VF, motion artifacts and oversensing of electrical signals. These shocks may be arrhythmogenic, result in injuries, precipitate WCD discontinuation, and they consume medical resources. Improved WCD sensing, rhythm discrimination, and methods to abort IAS are needed.
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Affiliation(s)
- Justin M Berger
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Jay D Sengupta
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Alan J Bank
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Susan A Casey
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Dawn Witt
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Scott W Sharkey
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Larissa I Stanberry
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Robert G Hauser
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA.
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Berger J, Hauser RG, Sharkey SW, Casey S, Witt DR, Berg A, Bank AJ, Grey E, Sengupta J. DESMOPLAKIN GENE MUTATION IS ASSOCIATED WITH MYOCARDITIS-LIKE PRESENTATION OF ARRHYTHMOGENIC CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Palmer M, Wong A, Hauser RG, Zakaib JS, Schwager S, Casey S, Kapphahn-Bergs M, Witt DR, Walser-Kuntz E, Sengupta J. SURVIVAL OF PATIENTS PACED WITH LEADLESS VERSUS CONDUCTION SYSTEM PACEMAKERS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Nowariak M, Casey S, Berg A, Hauser RG, Witt DR, Cavalcante JL, Sengupta J. TWO HEARTS OF A KIND. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Sengupta J, Xu K, Casey S, Peltier J, Stahl WK, Peterson N, Taylor AJ, Kippola JM, Settimi DS, Steele E, Hauser RG. PO-621-05 MAGNETIC FIELD INTERACTIONS BETWEEN CONTEMPORARY ELECTRONIC CONSUMER PRODUCTS AND CARDIAC IMPLANTABLE ELECTRONIC DEVICES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hauser RG, Gornick CC, Abdelhadi RH, Tang CY, Kapphahn-Bergs M, Casey SA, Okeson BK, Steele EA, Sengupta JD. Leadless Pacemaker Perforations: Clinical Consequences and Related Device and User Problems. J Cardiovasc Electrophysiol 2021; 33:154-159. [PMID: 34953099 PMCID: PMC9305184 DOI: 10.1111/jce.15343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
Background Cardiac perforation during leadless pacemaker implantation is more likely to require intervention than perforation by a transvenous lead. This study reports the consequences of Micra pacemaker perforations and related device and operator use problems based on information the manufacturer has submitted to the Food and Drug Administration (FDA). Methods FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for Micra perforations. Data extracted included deaths, major adverse clinical events (MACEs), and device and/or operator use problems. Results Between 2016 and July 2021, 563 perforations were reported within 30 days of implant and resulted in 150 deaths (27%), 499 cardiac tamponades (89%), 64 pericardial effusions (11%), and 146 patients (26%) required emergency surgery. Half of perforations were associated with 139 (25%) device problems, 78 (14%) operator use problems, and 62 (11%) combined device and operator use problems. Inadequate electrical measurements or difficult positioning were the most frequent device problems (n = 129); non‐septal implants and perforation of other structures were the most frequent operator use problems (n = 69); a combined operator use and device problem resulted in 62 delivery system perforations. No device or operator use problem was identified for 282 perforations (50%), but they were associated with 78 deaths, 245 tamponades, and 57 emergency surgeries. Conclusion The Micra perforations reported in MAUDE are often associated with death and major complications requiring emergency intervention. Device and use problems account for at least half of perforations. Studies are needed to identify who is at risk for a perforation and how MACE can be avoided or mitigated.
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Affiliation(s)
- Robert G Hauser
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Charles C Gornick
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Raed H Abdelhadi
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Chuen Y Tang
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Melanie Kapphahn-Bergs
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Susan A Casey
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Brynn K Okeson
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Elizabeth A Steele
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Jay D Sengupta
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
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Hauser RG, Gornick CC, Abdelhadi RH, Tang CY, Casey SA, Sengupta JD. B-PO02-037 INCREASING NUMBER OF SERIOUS ADVERSE EVENTS DURING AND AFTER LEADLESS PACEMAKER IMPLANTATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hauser RG. To the Editor- The "Guidant Affair": Little has changed since Joshua's death. Heart Rhythm 2021; 18:1462. [PMID: 33848648 DOI: 10.1016/j.hrthm.2021.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
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Link MS, Sullivan RM, Olshansky B, Cannom D, Berul CI, Hauser RG, Heidbuchel H, Jordaens L, Krahn AD, Morgan J, Patton KK, Saarel EV, Wilkoff BL, Li F, Dziura J, Brandt C, Barth C, Lampert R. Implantable Cardioverter Defibrillator Lead Survival in Athletic Patients. Circ Arrhythm Electrophysiol 2021; 14:e009344. [PMID: 33724879 DOI: 10.1161/circep.120.009344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark S Link
- Department of Internal Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas TX (M.S.L.)
| | | | | | - David Cannom
- Division of Cardiology, Department of Medicine, Cedar Sinai Heart Institute, Los Angeles, CA (D.C.)
| | - Charles I Berul
- Division of Cardiology, Department of Pediatrics, Children's National, Washington, DC (C.I.B.)
| | - Robert G Hauser
- Department of Medicine, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (R.G.H.)
| | - Hein Heidbuchel
- Cardiology, Antwerp University Hospital and Antwerp University, Belgium (H.H.)
| | - Luc Jordaens
- Department of Cardiology, Thoraxcentre, Rotterdam, the Netherlands (L.J.)
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada (A.D.K.)
| | - John Morgan
- University Hospital Southampton, United Kingdom (J.M.)
| | - Kristen K Patton
- Department of Medicine, University of Washington, Seattle (K.K.P.)
| | | | - Bruce L Wilkoff
- Tomsich Family Department of Cardiovascular Medicine (B.L.W.), Cleveland Clinic, OH
| | - Fangyong Li
- Yale University School of Medicine, Yale Center of Analytic Sciences, New Haven, CT (F.L., J.D., C. Brandt, C. Barth)
| | - James Dziura
- Yale University School of Medicine, Yale Center of Analytic Sciences, New Haven, CT (F.L., J.D., C. Brandt, C. Barth)
| | - Cynthia Brandt
- Yale University School of Medicine, Yale Center of Analytic Sciences, New Haven, CT (F.L., J.D., C. Brandt, C. Barth)
| | - Cheryl Barth
- Yale University School of Medicine, Yale Center of Analytic Sciences, New Haven, CT (F.L., J.D., C. Brandt, C. Barth)
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Hauser RG, Gornick CC, Abdelhadi RH, Tang CY, Casey SA, Sengupta JD. Major adverse clinical events associated with implantation of a leadless intracardiac pacemaker. Heart Rhythm 2021; 18:1132-1139. [PMID: 33713856 DOI: 10.1016/j.hrthm.2021.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leadless intracardiac pacemakers were developed to avoid the complications of transvenous pacing systems. The Medtronic Micra™ transcatheter pacemaker is one such system. We found an unexpected number of major adverse clinical events (MACE) in the Food and Drug Administration's Manufacturers and User Facility Device Experience (MAUDE) database associated with Micra implantation. OBJECTIVE The purpose of this study was to describe these MACE and compare them to implant procedure MACE in MAUDE for Medtronic CapSureFix™ active-fixation transvenous pacing leads. METHODS During January 2021, we queried the MAUDE database for reports of MACE for Micra pacemakers and CapSureFix leads using the simple search terms "death," "tamponade," and "perforation." Reports from 2016-2020 were included. RESULTS The search identified 363 MACE for Micra and 960 MACE for CapSureFix leads, including 96 Micra deaths (26.4%) vs 23 CapSureFix deaths (2.4%) (P <.001); 287 Micra tamponades (79.1%) vs 225 tamponades for CapSureFix (23.4%) (P <.001); and 99 rescue thoracotomies for Micra (27.3%) vs 50 rescue thoracotomies for CapSureFix (5.2%) (P <.001). More Micra patients required cardiopulmonary resuscitation (21.8% vs 1.1%) and suffered hypotension or shock (22.0% vs 5.8%) than CapSureFix recipients (P <.001). Micra patients were more likely to survive a myocardial perforation or tear if they had surgical repair (P = .014). CONCLUSION Micra leadless pacemaker implantation may be complicated by myocardial and vascular perforations and tears that result in cardiac tamponade and death. We estimate the incidence is low (<1%). Rescue surgery to repair perforations may be lifesaving. MACE are significantly less for implantation of CapSureFix transvenous ventricular pacing leads.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | | | | | - Chuen Y Tang
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Susan A Casey
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jay D Sengupta
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Jay D Sengupta
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Hauser RG, Casey SA, Gitter CB, Tang CY, Abdelhadi RH, Gornick CC, Stanberry L, Sengupta JD. Reliability and longevity of implantable defibrillators. J Interv Card Electrophysiol 2021; 62:507-518. [PMID: 33387130 PMCID: PMC8645539 DOI: 10.1007/s10840-020-00920-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/23/2020] [Indexed: 12/04/2022]
Abstract
Purpose We hypothesized that data in manufacturers’ product performance reports (PPRs) can provide clinically valuable ICD and cardiac resynchronization defibrillator (CRT-D) reliability and longevity information. Methods Data were obtained from 2019 PPRs. Kaplan-Meier (K-M) probabilities of freedom from malfunction, normal battery depletion (NBD), and NBD + malfunction were calculated for ICD and CRT-D pulse generators (PGs) with LiMnO2 or LiSVO/CFx batteries marketed in the USA from 2010 to 2019 and compared using the log-rank test. Malfunctions (MAL) included PGs that were found outside specifications. Results Study population included 1,149,803 ICD and CRT-D PGs: Abbott (ABT; 35.1%), Biotronik (BIO; 4.6%), Boston Scientific (BSC; 23.5%), and Medtronic (MDT; 36.9%). Significant differences in reliability (p < 0.001), defined by freedom from MAL, were found between manufacturers; the majority of 6808 MAL occurred in ABT devices (n = 4045; 59.4%), followed by BSC (n = 2384; 35.0%), MDT (n = 338;5.0%), and BIO (n = 41; 0.6%). Battery failure (n = 890; 57.9%) was the most common cause of MAL compromising therapy; analysis of unique ABT battery MAL–indicated problem appeared a year prior to advisory. Significant differences (p < 0.001) in battery longevity, as defined by freedom from NBD, were found between manufacturers. Overall performance (freedom from NBD + MAL) favored BSC for CRT-D PGs and MDT and BIO for ICDs. BSC subcutaneous ICD reliability was inferior to its transvenous ICD (p < 0.001). Conclusion PPRs contain valuable data that can be aggregated and analyzed to inform physicians. Differences in product reliability exist between manufacturers. Battery longevity has improved, but MAL have significantly impacted performance. PPR data may be useful for assessing product problems and new technology.
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Sengupta J, Storey K, Casey S, Trager L, Buescher M, Horning M, Gornick C, Abdelhadi R, Tang C, Brill S, Ashbach L, Hauser RG. Outcomes Before and After the Recall of a Heart Failure Pacemaker. JAMA Intern Med 2020; 180:198-205. [PMID: 31860011 PMCID: PMC6990820 DOI: 10.1001/jamainternmed.2019.5171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Timely and complete disclosure of medical device defects is necessary to manage patient care safely and effectively. OBJECTIVES To determine if the manufacturer's recommendations following the recall of a medical device were timely and complete, the follow-up information and data provided to patients and physicians were adequate for managing patient care, and the actions taken by the US Food and Drug Administration (FDA) regarding the recall were appropriate. DESIGN, SETTING, AND PARTICIPANTS This single-center retrospective case series included 90 of 448 patients who were implanted with a cardiac resynchronization therapy pacemaker at the Minneapolis Heart Institute from May 2003 through January 2011; this pacemaker was recalled in November 2015. In addition, returned product reports submitted by the manufacturer to the FDA via the Manufacturer and User Facility Device Experience (MAUDE) database from January 2008 through December 2018 were analyzed. MAIN OUTCOMES AND MEASURES Clinical outcomes were serious adverse clinical events that occurred before and after the November 2015 recall notifying physicians and patients that the device's battery could fail unexpectedly because of high internal impedance. Technical outcomes were signs and causes of failure. RESULTS Five of 90 patients observed during 2015 experienced syncope when their pacemakers stopped pacing owing to battery or wire connection defects prior to the recall. Of the 90 patients, 37 (41%) were men, and the median (interquartile range) age at implantation was 71.3 (66.1-78.2) years. Analysis of the MAUDE data revealed that battery failures prior to the recall were associated with serious adverse events that included 1 death, 1 cardiac arrest, 5 syncopal attacks, and 6 heart failure exacerbations; 3 additional prerecall syncopal events were caused by wire connection defects. The manufacturer and the FDA were aware of the battery and wire connection defects for 19 months before issuing the recall, yet the wire connection problem was not included in the advisory and physicians were not informed that interrogating the pacemaker could result in loss of pacing. The FDA classified the recall as class II rather than the more critical class I. CONCLUSIONS AND RELEVANCE This case series study of patients implanted with a defective pacemaker found that the pacemaker recall was delayed and that subsequent communications did not include all critical information needed for safe and effective patient care. These findings should prompt reforms in how the medical device industry and the FDA manage future medical device recalls.
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Affiliation(s)
- Jay Sengupta
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Katelyn Storey
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Susan Casey
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Lena Trager
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Mark Horning
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Charles Gornick
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Raed Abdelhadi
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Chuen Tang
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Suzanne Brill
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Laura Ashbach
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Hauser RG, Sengupta J, Casey S, Tang C, Stanberry LI, Abdelhadi R. High shocking and pacing impedances due to defibrillation lead calcification. J Interv Card Electrophysiol 2019; 58:253-259. [PMID: 31853803 PMCID: PMC7391391 DOI: 10.1007/s10840-019-00685-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 12/05/2022]
Abstract
Purpose We have reported the calcification of Endotak defibrillation leads that required replacement. The aim of this study was to assess calcified Endotak Reliance leads in the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database and compare them to calcified Sprint Fidelis, Sprint Quattro Secure, Riata, and Durata leads in MAUDE. Methods We searched the MAUDE database from 2008 to 2019 for defibrillation lead calcification using the terms “calcium,” “calcification,” and “calcified”. Included were explanted leads whose manufacturers found calcium on the shocking and/or pacing electrode. Results The MAUDE search identified 113 calcified defibrillation leads that qualified for the study, including 109 Endotak Reliance leads, 1 Sprint Quattro Secure lead, 2 Durata leads, 1 Riata ST lead, and no Sprint Fidelis lead. The sign of calcification was a gradual increase in shocking or pacing impedance. Average implant time was 7.4 ± 3.1 (range: 1.3–16.5) years. Only Endotak Reliance leads had shocking coil calcification (n = 72; 66.0%) and five (6.9%) of these failed defibrillation threshold (DFT) testing. Distal pacing electrode calcification affected 55 (50.4%) Endotak Reliance leads. The four other leads had pacing ring electrode calcification only. Conclusion Endotak Reliance defibrillation leads appear prone to shocking coil and/or distal pacing electrode calcification. High impedances may compromise defibrillation and pacing therapy. Patients who have these leads should be monitored; those exhibiting high shocking impedances should be considered for DFT testing. Lead replacement should be considered for pacemaker-dependent patients whose leads exhibit progressively high impedances.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, 55407, USA. .,, Long Lake, USA.
| | - Jay Sengupta
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, 55407, USA
| | - Susan Casey
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, 55407, USA
| | - Chuen Tang
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, 55407, USA
| | - Larissa I Stanberry
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, 55407, USA
| | - Raed Abdelhadi
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, 55407, USA
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Hauser RG, Sengupta J, Schloss EJ, Stanberry LI, Wananu MK, Abdelhadi R. Internal insulation breaches in an implantable cardioverter-defibrillator lead with redundant conductors. Heart Rhythm 2019; 16:1215-1222. [DOI: 10.1016/j.hrthm.2019.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 10/27/2022]
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Providência R, Kramer DB, Pimenta D, Babu GG, Hatfield LA, Ioannou A, Novak J, Hauser RG, Lambiase PD. Transvenous Implantable Cardioverter-Defibrillator (ICD) Lead Performance: A Meta-Analysis of Observational Studies. J Am Heart Assoc 2015; 4:e002418. [PMID: 26518666 PMCID: PMC4845221 DOI: 10.1161/jaha.115.002418] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the widespread use of implantable cardioverter-defibrillators (ICDs) in clinical practice, concerns exist regarding ICD lead durability. The performance of specific lead designs and factors determining this in large populations need clarification. METHODS AND RESULTS The Medline, Embase, and Cochrane Collaboration databases were searched for studies including ≥2 of the most commonly implanted leads. The Mantel-Haenszel random-effects model was used. Seventeen studies were selected, including a total of 49 871 patients-5538 implanted with Durata (St. Jude Medical Inc), 10 605 with Endotak Reliance (Boston Scientific), 16 119 with Sprint Quattro (Medtronic Corp), 11 709 with Sprint Fidelis (Medtronic Corp), and 5900 with Riata (St. Jude Medical Inc)-with follow-up of 136 509 lead-years. Although the Durata lead presented a numerically higher rate, no statistically significant differences in the mean incidence of lead failure (0.29%-0.45% per year) were observed in comparison of the 3 nonrecalled leads. A higher event rate was documented with the Riata (1.0% per-year increase) and Sprint Fidelis (>2.0% per-year increase) leads compared with nonrecalled leads. An indication of increased incidence of Durata lead failure versus Sprint Quattro and Endotak Reliance leads was observed in 1 of 3 included studies, allowing for comparison of purely electrical lead failure, but this requires further evaluation. CONCLUSIONS Endotak Reliance (8F), Sprint Quattro (8F), and Durata (7F) leads displayed low annual incidence of failure; however, long-term follow-up data are still scarce. More data are needed to clarify the performance and safety of the Durata lead.
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Affiliation(s)
- Rui Providência
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Daniel B. Kramer
- Cardiac ElectrophysiologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Dominic Pimenta
- University College of London Hospitals NHS TrustLondonUnited Kingdom
| | - Girish G. Babu
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
| | | | | | - Jan Novak
- Solothurner Spitaeler AGSolothurnSwitzerland
| | | | - Pier D. Lambiase
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
- University College of LondonUnited Kingdom
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
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Johnson BK, Garberich RF, Henry TD, Katsiyiannis WT, Sengupta J, Kalra A, Hauser RG, Lardy ME, Newell MC. Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system. Heart Rhythm 2015; 13:538-46. [PMID: 26576706 DOI: 10.1016/j.hrthm.2015.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies have shown mortality benefit for implantable cardioverter-defibrillators (ICDs) in ST-elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF), but contemporary eligibility and appropriate utilization of ICDs is unknown. OBJECTIVE The purpose of this study was to determine the contemporary eligibility and appropriate utilization of ICDs post-STEMI. METHODS Using the prospective Minneapolis Heart Institute regional STEMI registry, LVEF before discharge and at follow-up were stratified into 3 groups: normal (LVEF ≥50%), mildly reduced (LVEF 35%-49%), and severely reduced (LVEF <35%). RESULTS From March 2003 to June 2012, 3626 patients were treated. Patients with in-hospital death (n = 187), ICD in place (n = 21), negative cardiac biomarkers (n = 337), and undocumented in-hospital LVEF (n = 9) were excluded, leaving 3072 patients in the final analysis, including 1833 (59.7%) with LVEF ≥50%, 875 (28.5%) with LVEF between 35% and 49%, and 364 (11.8%) with LVEF <35% before hospital discharge. Overall, 1029 patients (33.5%) underwent follow-up echocardiography ≥40 days post-STEMI, including 140 of the 364 patients (38.5%) discharged with LVEF <35%. In total, 73 patients (7.1%) with follow-up echocardiography ≥40 days post-STEMI met criteria for an ICD (68 LVEF ≤30%, 5 LVEF 30%-35%, and New York Heart Association class II or greater). Only 26 of these patients (35.6%) underwent ICD placement within 1 year post-STEMI. Overall, only 10% to 15% of potentially eligible patients had an ICD implemented. CONCLUSION Rates of ICD implantation in appropriate STEMI patients after 40 days are low. Strategies are needed to identify and expand access to these high-risk patients.
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Affiliation(s)
- Benjamin K Johnson
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Hennepin County Medical Center, Minneapolis, Minnesota
| | - Ross F Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California
| | - William T Katsiyiannis
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Sengupta
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ankur Kalra
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Robert G Hauser
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Meghan E Lardy
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Marc C Newell
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota
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Kramer DB, Hatfield LA, McGriff D, Ellis CR, Gura MT, Samuel M, Retel LK, Hauser RG. Transvenous implantable cardioverter-defibrillator lead reliability: implications for postmarket surveillance. J Am Heart Assoc 2015; 4:e001672. [PMID: 26025935 PMCID: PMC4599526 DOI: 10.1161/jaha.114.001672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background As implantable cardioverter-defibrillator technology evolves, clinicians and patients need reliable performance data on current transvenous implantable cardioverter-defibrillator systems. In addition, real-world reliability data could inform postmarket surveillance strategies directed by regulators and manufacturers. Methods and Results We evaluated Medtronic Sprint Quattro, Boston Scientific Endotak, and St Jude Medical Durata and Riata ST Optim leads implanted by participating center physicians between January 1, 2006 and September 1, 2012. Our analytic sample of 2653 patients (median age 65, male 73%) included 445 St Jude, 1819 Medtronic, and 389 Boston Scientific leads. After a median of 3.2 years, lead failure was 0.28% per year (95% CI, 0.19 to 0.43), with no statistically significant difference among manufacturers. Simulations based on these results suggest that detecting performance differences among generally safe leads would require nearly 10 000 patients or very long follow-up. Conclusions Currently marketed implantable cardioverter-defibrillator leads rarely fail, which may be reassuring to clinicians advising patients about risks and benefits of transvenous implantable cardioverter-defibrillator systems. Regulators should consider the sample size implications when designing comparative effectiveness studies and evaluating new technology for preventing sudden cardiac death.
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Affiliation(s)
- Daniel B Kramer
- Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., M.S.) Hebrew SeniorLife Institute for Aging Research, Boston, MA (D.B.K.) Harvard Medical School, Boston, MA (D.B.K., L.A.H.)
| | | | - Deepa McGriff
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
| | | | - Melanie T Gura
- Northeast Ohio Cardiovascular Specialists, Akron, OH (M.T.G.)
| | - Michelle Samuel
- Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., M.S.)
| | - Linda Kallinen Retel
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
| | - Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.M.G., L.K.R., R.G.H.)
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Miedema MD, Schnaidt L, Garberich R, Newell M, Hauser RG, Henry T. LOW DENSITY LIPOPROTEIN CHOLESTEROL, CARDIOVASCULAR RISK, AND UTILIZATION OF CARE PRIOR TO ST-ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Skeik N, McGriff DM, Katsiyiannis WT, Sullivan TM, Mugglin AS, Retel LM, Hauser RG. Peripheral artery disease is an independent predictor of mortality after implantable cardioverter-defibrillator implantation in patients with severe left ventricular dysfunction. Angiology 2013; 65:507-11. [PMID: 23966571 DOI: 10.1177/0003319713499607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The impact of peripheral artery disease (PAD) on survival in implantable cardioverter defibrillator (ICD) patients is poorly understood. Thus, we assessed the risk of PAD in our adult ICD patients with left ventricular dysfunction (ejection fraction [EF] ≤35%). Survival was estimated with Kaplan-Meier method and compared by the log-rank test; a Cox proportional hazards model assessed the effects of clinical variables on survival. Average age and EF of 1399 patients were 67.0 ± 12.1 years and 23.8% ± 7.2%, respectively. The ICD patients with PAD had significantly worse survival than those without (unadjusted P < .0001). The multivariate predictors of survival at implant were (hazard ratio, HR [95% confidence interval]) age (HR 1.05 [1.04-1.07] P < .0001), PAD (HR 2.07 [1.53-2.80] P < .0001), class III/IV heart failure (HR 1.36 [1.06-1.76] P = .016), creatinine 1.4-2.0 mg/dL (HR 1.36 [1.05-1.76] P = .019), and creatinine ≥2.0 mg/dL (HR 2.01 [1.42-2.85] P < .0001). The PAD is an independent predictor of mortality and should be considered in the preimplant risk assessment.
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Deepa M McGriff
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - William T Katsiyiannis
- Electrophysiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Timothy M Sullivan
- Vascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Andrew S Mugglin
- Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Linda M Retel
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Robert G Hauser
- Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Christiansen EC, Wickstrom KK, Henry TD, Garberich RF, Rutten-Ramos SC, Larson DM, Grey EZ, Thiessen NL, Hauser RG, Newell MC. Comparison of functional recovery following percutaneous coronary intervention for ST elevation myocardial infarction in three age groups (<70, 70 to 79, and ≥80 years). Am J Cardiol 2013; 112:330-5. [PMID: 23642505 DOI: 10.1016/j.amjcard.2013.03.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/16/2013] [Accepted: 03/16/2013] [Indexed: 11/28/2022]
Abstract
Functional outcomes of elderly patients ≥80 years who undergo percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) are unknown. Registry data indicate that up to 55% of elderly patients with STEMI do not receive reperfusion therapy despite a suggested mortality benefit, and only limited data are available regarding outcomes in elderly patients treated with primary PCI. Therefore, prospective data from a regional STEMI transfer program were analyzed to determine major adverse cardiac events, length of stay, and discharge status of consecutive patients with STEMI ≥80 years from March 2003 to November 2006. Of the 1,323 consecutive patients with STEMI treated in this regional STEMI system from March 2003 to November 2006, 199 (15.0%) were ≥80 years old. In-hospital mortality in elderly patients was 11.6%, with a 1-year mortality rate of 25.6%. Of the 166 patients with age ≥80 who lived independently or in assisted living before hospital admission and survived, 150 (90.4%) were discharged to a similar living situation or projected to such a living situation after temporary nursing home care. The median length of hospital stay was 4 days for these patients. In conclusion, elderly patients with age ≥80 receiving PCI for STEMI in a regional STEMI program have short hospital stays and excellent functional recovery on the basis of a very high rate of return to a similar previous living situation.
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Affiliation(s)
- Ellen C Christiansen
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Hauser RG, Kallinen Retel LM. Early fatigue fractures in the IS-1 connector leg of a small-diameter ICD lead: value of returned product analysis for improving device safety. Heart Rhythm 2013; 10:1462-8. [PMID: 23871705 DOI: 10.1016/j.hrthm.2013.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conductor fractures may affect the performance of implantable cardioverter-defibrillator leads. During routine surveillance of returned product analyses (RPAs) in the Food and Drug Administration's Manufacturers and User Facility Device Experience database, we found a number of conductor fractures in small diameter implantable cardioverter-defibrillator leads manufactured by St Jude Medical, Inc (SJM, Sylmar, CA). OBJECTIVES To determine the location and cause of these fractures and to catalog their clinical signs and consequences. METHODS We searched the FDA's Manufacturers and User Facility Device Experience database on April 11, 2013. SJM provided information and data it collected independently. RESULTS Our search found 59 leads with fractures in the IS-1 leg. Most fractures were in leads implanted in 2008-2009; no fractures were found in leads implanted after 2010. Outer coil conductor fractures accounted for the majority (51 of 59, 86%). Oversensing and noise were common signs, and 81% of the patients received inappropriate shocks. SJM's RPAs found that the fractures were due to inadequate strain relief and redesigned the IS-1 leg by shortening the crimp bore. Younger age and subpectoral implants appeared to be associated with these fractures. SJM stated the incidence is low (0.040%) and has not seen further fractures of this type in leads with the modified crimp. CONCLUSIONS SJM's small diameter leads that were manufactured before 2011 are prone to early outer coil fatigue fractures in the IS-1 leg. The failure mechanism appears to have been mitigated by a design change. RPA is important for improving device safety.
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Affiliation(s)
- Robert G Hauser
- Patient Safety and Advocacy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute, 920 East 28th St, Suite 500, Minneapolis, MN 55407, USA.
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Abdelhadi RH, Saba SF, Ellis CR, Mason PK, Kramer DB, Friedman PA, Gura MT, DiMarco JP, Mugglin AS, Reynolds MR, Bazaz RR, Retel LK, Hayes DL, Hauser RG. Independent multicenter study of Riata and Riata ST implantable cardioverter-defibrillator leads. Heart Rhythm 2012; 10:361-5. [PMID: 23128017 DOI: 10.1016/j.hrthm.2012.10.045] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Riata and Riata ST leads (St Jude Medical, Sylmar, CA) are prone to failure. There are no independent multicenter reports regarding Riata or Riata ST lead performance. OBJECTIVE To conduct a retrospective multicenter study of Riata and Riata ST leads that were implanted and followed at 7 centers. METHODS The study included adults who received St Jude Medical Riata or Riata ST leads. Data for Quattro Secure leads were obtained from an earlier study. RESULTS From 2002 to 2010, 1081 patients received a Riata (n = 774) or Riata ST (n = 307) lead. Follow-up was longer for Riata than Riata ST leads (4.2 ± 2.4 years vs 3.3 ± 1.7 years; P<.0001). During the study, 67 leads failed (6.2%), including 62 of 774 Riata (8.0%) and 5 of 307 Riata ST (1.6%) leads. Forty-seven of 67 lead failures (70.1%) were caused by electrical malfunction, and 20 lead failures (29.9%) were due to externalized conductors (ECs) that were electrically intact. Of 110 leads examined fluoroscopically, ECs were found in 26 of 81 Riata (32%) and 1 of 29 Riata ST (3.4%) leads. Of 26 Riata leads with ECs, 7 (27%) were malfunctioning. Riata leads had lower overall and malfunction free survival compared to Quattro leads (P<.0001), while Riata ST lead survival was not different (P = .422). CONCLUSIONS The survival of Riata (but not Riata ST) leads was lower than Quattro leads; however, Riata ST leads had significantly shorter follow-up than Riata leads. ECs were common in Riata leads, and more than a quarter of Riata leads that had ECs were malfunctioning. Our observations suggest that systematic fluoroscopic examination of patients with Riata leads is appropriate.
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Affiliation(s)
- Raed H Abdelhadi
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
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Hauser RG, Abdelhadi RH, McGriff DM, Kallinen Retel L. Failure of a novel silicone-polyurethane copolymer (Optim™) to prevent implantable cardioverter-defibrillator lead insulation abrasions. Europace 2012; 15:278-83. [PMID: 22915789 PMCID: PMC3549219 DOI: 10.1093/europace/eus245] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The purpose of this study was to determine if Optim™, a unique copolymer of silicone and polyurethane, protects Riata ST Optim and Durata implantable cardioverter-defibrillator (ICD) leads (SJM, St Jude Medical Inc., Sylmar, CA, USA) from abrasions that cause lead failure. METHODS AND RESULTS We searched the US Food and Drug Administration's (FDA's) Manufacturers and User Device Experience (MAUDE) database on 13 April 2012 using the simple search terms 'Riata ST Optim™ abrasion analysis' and 'Durata abrasion analysis'. Lead implant time was estimated by subtracting 3 months from the reported lead age. The MAUDE search returned 15 reports for Riata ST Optim™ and 37 reports for Durata leads, which were submitted by SJM based on its analyses of returned leads for clinical events that occurred between December 2007 and January 2012. Riata ST Optim™ leads had been implanted 29.1 ± 11.7 months. Eight of 15 leads had can abrasions and three abrasions were caused by friction with another device, most likely another lead. Four of these abrasions resulted in high-voltage failures and one death. One failure was caused by an internal insulation defect. Durata leads had been implanted 22.2 ± 10.6 months. Twelve Durata leads had can abrasions, and six leads had abrasions caused by friction with another device. Of these 18 can and other device abrasions, 13 (72%) had electrical abnormalities. Low impedances identified three internal insulation abrasions. CONCLUSIONS Riata ST Optim™ and Durata ICD leads have failed due to insulation abrasions. Optim™ did not prevent these abrasions, which developed ≤ 4 years after implant. Studies are needed to determine the incidence of these failures and their clinical implications.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 500, Minneapolis, MN 55407, USA.
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Hauser RG, Abdelhadi R, McGriff D, Retel LK. Deaths caused by the failure of Riata and Riata ST implantable cardioverter-defibrillator leads. Heart Rhythm 2012; 9:1227-35. [PMID: 22449741 DOI: 10.1016/j.hrthm.2012.03.048] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Riata and Riata ST leads (St Jude Medical, Sylmar, CA) were recalled in 2011. These leads are prone to externalized conductors. However, it is electrical malfunctions that may result in serious adverse events, including death. OBJECTIVE To assess the deaths of patients with Riata and Riata ST leads that have been reported to the Food and Drug Administration to determine whether they were due to lead malfunction. A similar analysis was performed for Quattro Secure leads (Medtronic, Inc, Minneapolis, MN). METHODS In February 2012, we searched the Food and Drug Administration's Manufacturers and User Facility Device Experience database for deaths associated with Riata, Riata ST, and Quattro Secure leads. A lead-related death was a sudden or unexpected death accompanied by evidence of lead malfunction; an indeterminate death was a death that was nonsudden or evidence of lead malfunction was not provided; a not lead-related death was a death that was nonsudden and/or there was no evidence that the lead contributed to the patient's demise. RESULTS The Manufacturers and User Facility Device Experience database search found 133 deaths; of these, 22 were caused by Riata or Riata ST lead failure and 5 were caused by Quattro Secure lead failure. Riata and Riata ST lead failure deaths were typically caused by short circuits between high-voltage components. No death was due to externalized conductors. CONCLUSIONS Riata and Riata ST implantable cardioverter-defibrillator leads are prone to high-voltage failures that have resulted in death. These failures appeared to have been caused by insulation defects that resulted in short circuiting between high-voltage components. Externalized conductors were not a factor in these deaths.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
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Hauser RG, Kallinen L. RIATA ICD LEAD FAILURE: RESULTS OF THE MANUFACTURERS ANALYSIS OF RETURNED LEADS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hauser RG, Mugglin AS, Friedman PA, Kramer DB, Kallinen L, McGriff D, Hayes DL. Early Detection of an Underperforming Implantable Cardiovascular Device Using an Automated Safety Surveillance Tool. Circ Cardiovasc Qual Outcomes 2012; 5:189-96. [PMID: 22396584 DOI: 10.1161/circoutcomes.111.962621] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Postmarket medical device surveillance in the United States depends largely on voluntary reporting of adverse events. Consequently, early safety signals may be missed, exposing patients to potentially hazardous products. The aim of this study was to assess the feasibility of using an automated safety surveillance tool to detect early signals that a marketed implantable cardiac device was underperforming.
Methods and Results—
For this purpose, we performed simulated prospective monthly full-cohort and propensity-matched comparative survival analyses on our 3-center database of Sprint Fidelis and Quattro Secure implantable cardioverter-defibrillator leads, using a commercially available automated surveillance tool that was preset to trigger an alert if the log rank probability value was <0.05. During the study, 84 of 1035 Fidelis (8.1%) and 23 of 1675 Quattro (1.4%) leads failed. The simulated full-cohort analysis triggered a sustained alert for Fidelis leads beginning 13 months after the first implant and 2 years before Fidelis leads were removed from the market. Of the 1035 patients who had Fidelis leads, up to 969 (93.6%) were successfully matched to Quattro patients. In the propensity-matched analysis, the alert triggered 22 months after the first Fidelis implant and more than 1 year before the lead was recalled.
Conclusions—
An active automated safety surveillance system could have identified this implantable cardiovascular device problem substantially sooner than was achieved through existing postmarket surveillance methods. Such a tool, when applied to clinical registries and remote monitoring databases, may limit the exposure of large populations to underperforming and potentially hazardous cardiovascular devices.
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Affiliation(s)
- Robert G. Hauser
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
| | - Andrew S. Mugglin
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
| | - Paul A. Friedman
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
| | - Daniel B. Kramer
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
| | - Linda Kallinen
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
| | - Deepa McGriff
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
| | - David L. Hayes
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K., D.M.M.); the Mayo Clinic, Rochester, MN (P.A.F., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (D.B.K.); and the University of Minnesota (Biostatistics), Minneapolis, MN (A.S.M.)
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Kramer DB, Friedman PA, Kallinen LM, Morrison TB, Crusan DJ, Hodge DO, Reynolds MR, Hauser RG. Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators. Heart Rhythm 2012; 9:42-6. [DOI: 10.1016/j.hrthm.2011.08.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/31/2011] [Indexed: 11/27/2022]
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Hauser RG, McGriff D, Retel LK. Riata implantable cardioverter-defibrillator lead failure: analysis of explanted leads with a unique insulation defect. Heart Rhythm 2011; 9:742-9. [PMID: 22209723 DOI: 10.1016/j.hrthm.2011.12.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Riata family of implantable cardioverter-defibrillator leads (St Jude Medical, Sylmar, CA) appears prone to a unique failure mechanism whereby the conductor cables wear through the silicone insulation from inside-out and are seen outside the lead body (externalized conductors). OBJECTIVE To assess the extent of Riata lead damage associated with inside-out insulation defects and their clinical consequences. METHODS In September 2011, we searched the U.S. Food and Drug Administration's Manufacturers and User Defined Experience medical device database for reports describing Riata lead failures that had been analyzed by the manufacturer. RESULTS The Manufacturers and User Defined Experience search identified 105 leads that had inside-out insulation defects. Eight-French single-coil Riata leads accounted for a higher-than-expected proportion (25.7%) of the leads with this defect. A total of 226 insulation defects were found in the 105 leads (2.2 defects per lead), including 143 inside-out defects (1.4 defects per lead). The most common location of insulation defects was distal to the proximal coil (n = 108). Twenty-eight leads (26.7%) had inside-out insulation defects underneath the shocking coils. Of 43 leads whose cables were assessed for the integrity of the ethylene-tetrafluoroethylene cable coating, 22 (51.2%) were found to be abraded, exposing the conductor surfaces. On X-ray radiography or fluoroscopy, 7 leads were found to have externalized cables; 2 of these leads had no electrical abnormalities, while 4 exhibited noise or increased impedance. Inappropriate shocks were experienced by 31 of the 105 patients (29.5%). CONCLUSION Riata leads that have inside-out insulation defects often have multiple defects, including additional inside-out abrasions along the body of the lead and beneath the shocking coils. Eight-French single-coil Riata models may be more prone to externalized cables than are dual-coil and 7-F designs. Externalized cables are but one manifestation of interior insulation damage. Our findings question the durability of the ethylene-tetrafluoroethylene cable coating on exposed cables.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
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Hauser RG, Maisel WH, Friedman PA, Kallinen LM, Mugglin AS, Kumar K, Hodge DO, Morrison TB, Hayes DL. Longevity of Sprint Fidelis Implantable Cardioverter-Defibrillator Leads and Risk Factors for Failure. Circulation 2011; 123:358-63. [DOI: 10.1161/circulationaha.110.975219] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Sprint Fidelis (Fidelis) implantable cardioverter-defibrillator leads are prone to fractures that have caused adverse events, primarily inappropriate shocks, and a few reported deaths. More than 100 000 patients have Fidelis leads. No independent multicenter long-term performance information exists for this lead, and single-center studies suggest that certain patients are at increased risk for Fidelis failure. Our aim was to assess the longevity of Fidelis leads and to evaluate clinical variables and adverse events associated with Fidelis failure. The results were compared with like data for Quattro Secure (Quattro) implantable cardioverter-defibrillator leads implanted at our centers.
Methods and Results—
This 3-center study included adults ≥18 years of age who received Fidelis or Quattro leads for the prevention of sudden cardiac death. From November 2001 to January 2009,1023 Fidelis and 1668 Quattro leads were implanted and followed up. The failure rate for Fidelis leads was 2.81%/y compared with 0.43%/y for Quattro leads (
P
<0.0001). No deaths or injuries occurred as a result of lead failure, but 42% of fractures caused inappropriate shocks. The survival of Fidelis leads at 4 years was 87.0% (95% confidence interval, 83.6 to 90.1) compared with 98.7% (95% confidence interval, 97.9 to 99.4) for Quattro leads (
P
<0.0001). Multivariate predictors of Fidelis failure were younger age (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99), female gender (hazard ratio, 0.61; 95% confidence interval, 0.40 to 1.00), and cardiac disease (
P
=0.041).
Conclusions—
Compared with Quattro leads, the survival of Fidelis leads continues to decline, and Fidelis failure is notably higher in younger patients, women, individuals with hypertrophic cardiomyopathy, and patients with arrhythmogenic right ventricular dysplasia or channelopathies. These findings have significant implications for the management of patients who have Fidelis leads, and they demonstrate the importance of weighing clinical variables in assessments of implantable cardioverter-defibrillator lead performance.
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Affiliation(s)
- Robert G. Hauser
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - William H. Maisel
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - Paul A. Friedman
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - Linda M. Kallinen
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - Andrew S. Mugglin
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - Kapil Kumar
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - David O. Hodge
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - Thomas B. Morrison
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
| | - David L. Hayes
- From the Minneapolis Heart Institute Foundation, Minneapolis, MN (R.G.H., L.M.K.); Mayo Clinic, Rochester, MN (P.A.F., D.O.H., T.B.M., D.L.H.); Beth Israel Deaconess Medical Center, Boston, MA (W.H.M., K.K.); and University of Minnesota (Biostatistics), Minneapolis (A.M.)
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Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol 2010; 55:333-41. [PMID: 20117439 DOI: 10.1016/j.jacc.2009.08.057] [Citation(s) in RCA: 657] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 07/24/2009] [Accepted: 08/20/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event. BACKGROUND Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning. METHODS Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients. RESULTS Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were <or=50 years of age. In 121 patients (89%), SC was precipitated by intensely stressful emotional (n = 64) or physical (n = 57) events, including 22 associated with sympathomimetic drugs or medical/surgical procedures; 15 other patients (11%) had no evident stress trigger. Twenty-five patients (18%) were taking beta-blockers at the time of SC events. Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance (CMR) imaging, usually with rapid return to normal systolic function, although delayed >2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year. CONCLUSIONS In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male, <or=50 years of age, without a stress trigger, or with in-hospital death, nonfatal recurrence, embolic stroke, or delayed normalization of ejection fraction. Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality. These data support expanded management and surveillance strategies including CMR imaging and consideration for anticoagulation.
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Affiliation(s)
- Scott W Sharkey
- Hypertrophic Cardiomyopathy Center and Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA
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Grey E, Pastorius CA, Henry TD, Duval S, Windenburg DC, Hauser RG. GENDER OUTCOMES IN A COMMUNITY LEVEL 1 PROGRAM OF CATHETER-BASED RAPID REPERFUSION FOR ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hauser RG. Development and Industrialization of the Implantable Cardioverter-Defibrillator: A Personal and Historical Perspective. Card Electrophysiol Clin 2009; 1:117-127. [PMID: 28770778 DOI: 10.1016/j.ccep.2009.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is the standard of care for preventing sudden cardiac death. Contemporary ICDs are capable of providing a variety of therapeutic functions and can automatically gather and store diagnostic data that can guide both device and drug therapy and alert caregivers of impending battery depletion or lead problems. Moreover, much of the diagnostic data can be monitored remotely, so that many patients can be evaluated in their homes. This article, by a former chief executive officer of the first company to commercialize the ICD, traces the history of the device from its beginnings in the early 1980s.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 300, Minneapolis, MN 55407, USA
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Hauser RG, Katsiyiannis WT, Gornick CC, Almquist AK, Kallinen LM. Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction. Europace 2009; 12:395-401. [PMID: 19946113 PMCID: PMC2825385 DOI: 10.1093/europace/eup375] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS An estimated 10,000-15,000 pacemaker and implantable cardioverter-defibrillator (ICD) leads are extracted annually worldwide using specialized tools that disrupt encapsulating fibrous tissue. Additional information is needed regarding the safety of the devices that have been approved for lead extraction. The aim of this study was to determine whether complications due to device-assisted lead extraction might be more hazardous than published data suggest, and whether procedural safety precautions are effective. METHODS AND RESULTS We searched the US Food and Drug Administration's (FDA) Manufacturers and User Defined Experience (MAUDE) database from 1995 to 2008 using the search terms 'lead extraction and death' and 'lead extraction and injury'. Additional product specific searches were performed for the terms 'death' and 'injury'. Between 1995 and 2008, 57 deaths and 48 serious cardiovascular injuries associated with device-assisted lead extraction were reported to the FDA. Owing to underreporting, the FDA database does not contain all adverse events that occurred during this period. Of the 105 events, 27 deaths and 13 injuries occurred in 2007-2008. During these 2 years, 23 deaths were linked with excimer laser or mechanical dilator sheath extractions. The majority of deaths and injuries involved ICD leads, and most were caused by lacerations of the right atrium, superior vena cava, or innominate vein. Overall, 62 patients underwent emergency surgical repair of myocardial perforations and venous lacerations and 35 (56%) survived. CONCLUSION These findings suggest that device-assisted lead extraction is a high-risk procedure and that serious complications including death may not be mitigated by emergency surgery. However, skilled standby cardiothoracic surgery is essential when performing pacemaker and ICD lead extractions. Although the incidence of these complications is unknown, the results of our study imply that device-assisted lead extractions should be performed by highly qualified physicians and their teams in specialized centres.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 300, Minneapolis, MN 55407, USA.
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Hauser RG, Hayes DL. Increasing hazard of Sprint Fidelis implantable cardioverter-defibrillator lead failure. Heart Rhythm 2009; 6:605-10. [DOI: 10.1016/j.hrthm.2009.02.024] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 02/11/2009] [Indexed: 10/21/2022]
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