Lead Abandonment and Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) Implantation in a Cohort of Patients With ICD Lead Malfunction

Abstract

Background: When an implantable-cardioverter defibrillator (ICD) lead becomes non-functional, a recommendation currently exists for either lead abandonment or removal. Lead abandonment and subcutaneous ICD (S-ICD) implantation may represent an additional option for patients who do not require pacing. The aim of this study was to investigate the outcomes of a strategy of lead abandonment and S-ICD implantation in the setting of lead malfunction. Methods: We analyzed all consecutive patients who underwent S-ICD implantation after abandonment of malfunctioning leads and compared their outcomes with those of patients who underwent extraction and subsequent reimplantation of a single-chamber transvenous ICD (T-ICD). Results: Forty-three patients underwent S-ICD implantation after abandonment of malfunctioning leads, while 62 patients underwent extraction and subsequent reimplantation of a new T-ICD. The two groups were comparable. In the extraction group, no major complications occurred during extraction, while the procedure failed and an S-ICD was implanted in 4 patients. During a median follow-up of 21 months, 3 major complications or deaths occurred in the S-ICD group and 11 in the T-ICD group (HR 1.07; 95% CI 0.29-3.94; P = 0.912). Minor complications were 4 in the S-ICD group and 5 in the T-ICD group (HR 2.13; 95% CI 0.49-9.24; P = 0.238). Conclusions: In the event of ICD lead malfunction, extraction avoids the potential long-term risks of abandoned leads. Nonetheless the strategy of lead abandonment and S-ICD implantation was feasible and safe, with no significant increase in adverse outcomes, and may represent an option in selected clinical settings. Further studies are needed to fully understand the potential risks of lead abandonment. Clinical Trial Registration: URL: ClinicalTrials.gov Identifier: NCT02275637.

Keywords: implantable defibrillator; lead abandonment; lead extraction; lead malfunction; subcutaneous.

Conflict of interest statement

ML and SV are employees of Boston Scientific. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Russo, Viani, Migliore, Nigro, Biffi, Tola, Bisignani, Dello Russo, Sartori, Rordorf, Ottaviano, Perego, Checchi, Segreti, Bertaglia, Lovecchio, Valsecchi and Bongiorni.

Figures

Figure 1

Kaplan-Meier estimates of time to the primary endpoint, according to intention-to-treat principle.

Figure 2

Kaplan-Meier estimates of time to first minor complication, according to intention-to-treat principle.

Figure 3

A 33-year-old woman with a Long QT Syndrome received a single-chamber T-ICD and a dual-coil lead via a persistent left superior vena cava (PLSVC) after a cardiac arrest. A new single-coil ICD lead was added five years later owing to malfunction of the first one, which was abandoned (a). After seven years, the second ICD lead also malfunctioned. Angiography showed complete occlusion of the PLSVC, with a variant venous circulation from an accessory hemiazygos vein. The dual-coil ICD lead (*) and the single-coil lead (#) are visible in (b,c). In this setting, lead extraction was considered to be at very high risk of venous laceration, while implantation of a new lead from the right side was deemed inappropriate because of the patient's young age. Finally, an S-ICD was implanted and both leads were abandoned (d,e). * dual-coil lead # single-coil lead.