Indications for ICD lead extraction and influence of the ICD lead model on lead survival

Abstract Background There is limited knowledge about ICD lead lifespan, reasons of lead failure and difference in functionality of different lead models. The goal. Our aim was a comparative analysis of the lifetime of individual lead models and the reasons for their extraction. Methods Analysis of 3929 transvenous lead extraction (TLE) procedures (including 1068 ICD lead extractions). Results The mean age of an ICD lead extracted (for all causes) is 61 months and two years shorter than pacemaker leads. Old models of thick leads lasted almost twice as long as thin leads of the transitional period (Riata, Sprint Fidelis) and modern leads. ICD leads are most commonly removed for infection (35.6%), mechanical damage (33.6%) and due to dysfunction (including perforation) (20.8%). Riata is most often removed due to infection (40.3%), but Sprint-Fidelis and Linox - due to lead damage (electric failure) (58.9 and 48.1% respectively). Perforations were more common in Riata cases (14.5%) than in Sprint Fidelis and Linox cases (4.3 and 8.4% respectively). Riata leads were extracted due to their mechanical damage later in time (mean age 124 months) in comparison with Sprint Fidelis and Linox (47 and 70 months respectively) as well as due to dysfunction of the undamaged lead (mean age 74, 55 and 61 months respectively). Durata leads were extracted due to mechanical damage later in time in comparison with Sprint Fidelis and Linox (mean age 81, 68 and 70 months respectively). However, the differences in age of extracted ICD leads did not turn out to be statistically significant. Riata leads lasted almost twice as long as Sprint Fidelis. Linox leads lasted as long as theoretically fail-safe Sprint Quatro leads. Conclusion 1. Mean age of ICD lead extracted is 61 months and is 2 years shorter in comparison with PM leads. 2. ICD leads are most commonly removed for infection (35.6%), mechanical lead damage (33.6%) and due to undamaged lead dysfunction (including perforation) (20.8%). 3. Old models of thick leads (Sprint, Ventritex and Kainox) lasted almost twice as long as thin leads of the transition period (Riata, Sprint Fidelis) and modern leads. 4. Perforations were more common in Riata cases (14.5%) than in case of other thin leads but differences of indications for different models from different manufacturers are nonsignificant. 5. Despite advances in the design of ICD leads, their lifetime does not change significantly, which indicates the role of factors other than the design of the lead in lead lifespan.