Response to Letter Regarding Article, “Complications Associated With Revision of Sprint Fidelis Leads: Report From the Canadian Heart Rhythm Society Device Advisory Committee”

Preventing Overdiagnosis of Implantable Cardioverter-Defibrillator Lead Fractures Using Device Diagnostics

“…Rapid diagnosis is important because the time between abnormal diagnostics and 1 or multiple inappropriate shocks caused by rapid oversensing may be short (1,3,4). However, lead replacement is associated with significant morbidity and rare deaths (5), and an incorrect diagnosis may result in replacement of normally functioning leads (6).…”

“…Early diagnosis of ICD lead fractures is important to reduce morbidity from loss of pacing, inappropriate ICD shocks, and/or ineffective treatment of ventricular tachyarrhythmias (1-4); however, overdiagnosis may result in unnecessary lead replacement risking morbidity and rare deaths (5). ICD diagnostics facilitate identification of fractures (1)(2)(3)(4)11), but individual diagnostics are nonspecific (3,8,11).…”

Dual- versus single-coil implantable defibrillator leads: review of the literature

“…Even in very experienced hands, transvenous ICD-lead extraction is associated with a significant interventionrelated complication rate [2,[56][57][58][59][60][61][62][63][64][65][66][67]. The extraction of dual-coil ICD leads may be associated with an increased risk, compared to the extraction of single-coil leads or pacing leads [1,58,59].…”

Outcomes of Sprint Fidelis and Riata lead extraction: Data from 2 high-volume centers

“…7,15,16 However, our study, along with others, shows that the risk of mortality and major complications associated with extraction of recalled leads is low (o1% and o2%, respectively). Given the increased risk of lead failure with time 4 and after generator replacement, 5,6 along with the high prevalence of subclinical fracture 17 or externalized conductors 13 in electrically normally functioning leads, one might argue that prophylactic LE at the time of generator replacement should be offered to patients after a full discussion of the risks and benefits of such an approach.…”