Komplikationen mit Sonden bei 340 Patienten mit einem implantierbaren Kardioverter/Defibrillator

Schwacke, Harald; Drögemüller, Axel; Siemon, G.; Werling, Christiane; Saggau, W; Senges, Jochen; Seidl, K.

doi:10.1007/s003920050326

Cited by 19 publications

(13 citation statements)

References 15 publications

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“…In fact, published overall complication rates range from 3.9% to 53%, with lead-related complications varying between 2.1% and 22%. With 13.3% (32 of 240) overall and 7.9% (20 of 240) lead-related complications, the present study was comparable with other mid-term follow-up trials in newer generation ICDs (2,4,5).…”

Section: Discussionsupporting

confidence: 86%

“…The majority of complications are leadrelated and occur within three months after device implantation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11); however, even during long-term follow-up, system-related complications are encountered (1,3,(12)(13)(14)(15)(16). Keeping in mind that many of these complications are potentially life-threatening, immediate detection would be desirable to ensure maximal safety.…”

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confidence: 99%

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Patient alert in implantable cardioverter defibrillators: toy or tool?

Becker

Ruf-Richter

Senges-Becker

et al. 2004

Journal of the American College of Cardiology

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Section: Discussionsupporting

confidence: 86%

mentioning

confidence: 99%

Patient alert in implantable cardioverter defibrillators: toy or tool?

Becker

Ruf-Richter

Senges-Becker

et al. 2004

Journal of the American College of Cardiology

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“…However, the rate of complications in dual chamber ICDs due to the additional atrial lead is higher compared to single chamber ICD systems 10,11 . Therefore, the aim of the presented study was to evaluate a single lead dual chamber ICD system that has been described recently in a chronic follow‐up.…”

Section: Introductionmentioning

confidence: 99%

Chronic Experiences with a Single Lead Dual Chamber Implantable Cardioverter Defibrillator System

Niehaus

Sousa

Klein

et al. 2003

Pacing Clinical Electrophis

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Monitoring of atrial rhythm in patients implanted with ICDs may improve accuracy in identifying supraventricular arrhythmias and, therefore, prevent inappropriate therapies. Since difficulties were found in dual chamber ICDs with separate leads, a new designed single lead dual chamber ICD system was tested. Twenty-five patients implanted with a Deikos A+ (single coil defibrillation lead with two atrial sensing rings combined with a dual chamber ICD with a high amplifying atrial channel) were tested. Atrial and ventricular signals were analyzed during sinus rhythm (SR) and sinus tachycardias (STs), atrial flutter and AF, and VT or VF. Follow-ups were performed after 1, 3, 6, 9, and 12 months after implantation. Analysis of EGM amplitudes of stored episodes revealed that atrial signals during atrial flutter (2.1 +/- 0.51 mV) were comparable to those of ST (2.2 +/- 0.5 mV). Atrial amplitudes during AF were significantly lower (0.81 +/- 0.5 mV, P<0.01). During VF atrial "sinus" signals (2 +/- 0.8 mV) were stable. Ventricular parameters did not differ from a standard ICD lead; defibrillation threshold was 11.4 +/- 4.5 J (16 patients). During intraoperative and prehospital discharge measurements, 97.1% of SR-P waves and 99.2% of atrial flutter waves were detected correctly. In AF 91.11% of atrial signals were detected. Analysis of 505 stored episodes showed that 96.8% of ST and 100% of atrial flutter and 100% of AF episodes have been classified correctly and no underdetection of VT/VF was found. The first experiences with the new VDD-ICD system show an increase of the specificity to detect ventricular tachycardias to a level comparable to dual chamber ICDs with two leads. The reliability of this system has to be proven in a prospective randomized study.

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“…[3][4][5] Lead fractures alone are less common, 0.9% in the series of Gallik et al 4 Two particular sites of lead fracture were noted, i.e. one at the clavicle, first rib junction, and the other within the generator pocket.…”

Section: Discussionmentioning

confidence: 99%

High voltage lead failure diagnosed at upgrade of single-chamber ICD to dual-chamber ICD with CRT

Kaźmierczak¹,

Rzeuski²,

Peregud‐Pogorzelska³

et al. 2006

EP Europace

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We describe a case of defibrillation lead damage which was detected only during an upgrade procedure from single-chamber ICD to dual-chamber ICD with biventricular pacing. The damage was not detected during routine checks in the ICD clinic. In February 2005, the patient was hospitalized on three occasions due to deterioration of heart failure to NYHA IV. Improvement to NYHA III with an EF ¼ 15% was achieved on last hospitalization with administration of cilazapril, carvedilol, furosemide, and spironolactone. ECG showed regular sinus rhythm, 90 bpm, features of old anterior and inferior myocardial infarction, and QRS duration of 135 ms. Cardiac transplantation was considered. Echocardiographic studies confirmed inter-and intraventricular dyssynchrony and cardiac resynchronization therapy (CRT) was selected. The single-chamber ICD, implanted 6 years before, was explanted. A unipolar left ventricular (LV) lead (Attain OTW, Medtronic Inc., Minneapolis, MN, USA) via percutaneous left subclavian approach was implanted. The lateral cardiac vein was used as the site of LV stimulation. An atrial lead was introduced via the same access and placed in the right atrial appendage (Figure 1). Satisfactory pacing parameters were achieved (pacing threshold ,0.5 V; 0.4 ms for both leads). Pacing threshold and resistance of LV lead were checked only in unipolar configuration. A dual-chamber ICD with CRT function (Insync III Protect, Medtronic) was implanted. During the upgrade procedure, no defibrillation test was performed because the last spontaneous appropriate shock was effective with correct defibrillation impedance and the procedure did not involve the defibrillation lead. KEYWORDSAfter the placement of the new ICD in the pocket, the parameters of all leads were checked. Atrial and right ventricular lead (bipolar pace/sense channel of defibrillation lead) showed pacing threshold and sensing similar to external measurements. The LV lead, however, showed impedance .2500 ohm with no capture. Therefore, the lead was disconnected and again checked by the external analyzer showing pacing threshold to be ,0.5 V; 0.4 ms and impedance 830 ohm. Radiologically, the lead position had not moved in three projections. Our conclusion was that the LV pacing channel in the ICD was faulty. We decided to implant another device (Insync III Protect) which again showed no LV pacing and high impedance (.2500 ohm). Therefore, we checked other LV pacing configurations: LV tip-RV tip, LV tip-RV ring, and LV tip-RV coil. We found that the LV was not paced only with LV tip-RV coil configuration, but this particular configuration was the only one available in the Insync III Protect ICD (apart from LV tip-LV ring for a bipolar LV lead).1 This explained the lack of pacing by the new ICD, but of great importance, it gave evidence of failure of the high voltage lead, necessary for defibrillation. Failure of the defibrillation lead was demonstrated by a low energy (1 J) test synchronized shock. Dissection of the extravenous part of the lead

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Komplikationen mit Sonden bei 340 Patienten mit einem implantierbaren Kardioverter/Defibrillator

Cited by 19 publications

References 15 publications

Patient alert in implantable cardioverter defibrillators: toy or tool?

Patient alert in implantable cardioverter defibrillators: toy or tool?

Chronic Experiences with a Single Lead Dual Chamber Implantable Cardioverter Defibrillator System

High voltage lead failure diagnosed at upgrade of single-chamber ICD to dual-chamber ICD with CRT

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