Introduction Data on long‐term durability of St Jude Medical Durata defibrillation leads compared to its previous model, the St Jude Medical Riata leads in clinical practice are missing. Aim of the study was to analyze the long‐term performance of the Durata defibrillation leads compared to the Riata leads in clinical practice. Methods and Results A total of 1407 consecutive patients of a prospective single‐centre implantable cardioverter defibrillator (ICD)‐registry were analyzed who underwent ICD implantation with a Durata (n = 913) or Riata (n = 494) ICD lead between 2002 and 2017. Most of the leads were implanted via a subclavian vein access. The estimated lead defect rates after 5 and 10 years were not different between the Durata (11% and 36%) and Riata leads (13% and 38%). Among Durata leads single coil and DF‐4 connector ICD leads had a lower incidence of lead failure. Major causes of lead failure were compression of the lead in the clavicular region, generator to lead friction and distal fatigue fracture whereas lead defect due to externalization was a rare cause of lead defect in Riata leads (3%). Conclusion Among ICD leads implanted via the subclavian vein access the lead defect rate of Durata leads after 10 years is similar to that of Riata leads. Single coil and DF‐4 ICD leads are associated with a lower lead failure rate. Mechanical stress represents a major cause of lead failure mechanism whereas externalization might only play a minor role in clinical practice.

Background Implantable cardioverter defibrillator (ICD) was implemented into clinical routine more than 20 years ago. Since then, ICD therapy became standard therapy for primary and secondary prevention of sudden cardiac death in clinical practice. Objectives Aim of the study was to evaluate the benefit‐harm profile of contemporary primary prophylactic ICD therapy. Methods A total of 1222 consecutive patients of a prospective single‐center ICD‐registry were analyzed who underwent primary prophylactic ICD implantation between 2000 and 2017. Patients were divided into two groups according to the implantation year: 2010‐2017 (group 1, n = 579) and 2000‐2009 (group 2, n = 643). Results The rate of estimated appropriate ICD therapy after 8 years was 51% in the 2000s and 42% in the 2010s (P < .001). The complication rate changed slightly from 53% to 47% (P = .005). This decline was mainly driven by the reduction of inappropriate ICD shocks (30% vs 14%, P < .001) whereas the rate of ICD shock lead malfunction and device/ lead infection remained unchanged over time. Nonischemic cardiomyopathy was an independent predictor for ICD complications without benefit of ICD therapy (HR 1.37, 95% CI 1.07‐1.77). Conclusion The ICD therapy rate for ventricular arrhythmias in patients with primary prophylactic ICD implantation is decreasing over the last two decades. Complication rate remains high due to an unchanged rate of ICD shock malfunctions and device infections. Nonischemic cardiomyopathy is an independent predictor for ICD complications without benefit of ICD therapy in primary prophylactic ICD‐therapy.

Background The role of triggers in the occurrence of appropriate ICD shocks due to ventricular tachyarrhythmias is not well known. The aim of the study was to assess the prevalence of trigger factors in appropriate ICD shocks and to analyze their prognostic impact on clinical outcome. Methods A total of 710 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2000 and 9/2021 were analyzed. Results In 35% of ICD patients with first ICD shock, at least one of the following triggers was found: Ischemia (22%), Compliance (9%), Decompensation (38%), Stress (12%), Technical (5%), Electrolyte/endocrinological disorder (22%) and Medication intoxication (4%) (Table 1). The trigger factors can be summarized under the acronym ICD-STEMi. Patients with trigger associated ICD shocks had a more depressed ejection fraction and presented more often with ventricular fibrillation or electrical storm. The therapy after VT/VF shock in the trigger group comprised trigger optimization in 100% and heart failure optimization in 21% as compared to 0% respectively 10% in the no-trigger group (p&lt;0.001). The ventricular arrhythmia therapy (antiarrhythmics or VT ablation) was not different between both groups (35% in each group). Patients with triggered first ICD shock had an increased 5-year mortality rate (50% versus 38%, p&lt;0.001) (Figure 1). Conclusions In one third of ICD patients with first appropriate ICD shock, at least one trigger can be identified. Finding a trigger strongly influenced therapy after VT/VF shock. Patients with triggered ICD shock have a higher 5-year mortality rate. The evaluation of trigger factors after the occurrence of ICD shocks is mandatory and can be systematically evaluated using the acronym ICD-STEMi. Funding Acknowledgement Type of funding sources: None.

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