Heart Rhythm
Volume 7, Issue 7 , Pages 890-897, July 2010

Effectiveness of implantable cardioverter-defibrillator lead coil treatments in facilitating ease of extraction

  • Joseph W. Hackler, DO

      Affiliations

    • Department of Internal Medicine, Medicine Institute, Cleveland, Ohio
    • ,
  • Zhiyuan Sun, MS

      Affiliations

    • Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
    • ,
  • Bruce D. Lindsay, MD

      Affiliations

    • Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Bruce L. Wilkoff, MD

      Affiliations

    • Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
    • Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
    • ,
  • Mark J. Niebauer, MD, PhD

      Affiliations

    • Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Patrick J. Tchou, MD

      Affiliations

    • Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Mina K. Chung, MD

      Affiliations

    • Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
    • Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
    • Corresponding Author InformationAddress reprint requests and correspondence: Mina K. Chung, M.D., Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-2, Cleveland, Ohio 44195

Received 10 February 2010; accepted 21 April 2010. published online 26 April 2010.

Background

Expanded polytetrafluoroethylene (ePTFE) coated and medical adhesive back-filled (MABF) implantable cardioverter-defibrillator (ICD) coils have been promoted to reduce the fibrous ingrowth into coils that can complicate lead extraction.

Objective

The purpose of this study was to test the hypothesis that ePTFE or MABF coatings are associated with greater ease of extraction.

Methods

Consecutive isolated ICD lead extraction cases were identified from a prospectively collected clinical database. Primary endpoints included total procedure and fluoroscopy times, radiation dose, and fibrosis sites. Data were analyzed using univariate and multivariate analyses in total and propensity-matched groups, adjusting for lead age and other factors.

Results

Among 329 patients (80% male; age 63.7 ± 5.4 years), 284 (86.3%) had standard coil ICD and 45 (13.7%) had treated coil ICD leads extracted, of which 17 (5.2%) were ePTFE coated and 28 (8.5%) were MABF ICD leads. The ePTFE and MABF leads were associated with lower procedure and fluoroscopy times, radiation dose, and fibrosis sites, even after adjustment for lead age, which was significantly shorter in the treated coil leads. To further adjust for the difference in lead age, a propensity-matched group was analyzed. Procedure time, fluoroscopy time, radiation dose, and brachiocephalic fibrosis remained significantly lower in the treated coil lead group.

Conclusions

The ePTFE- and MABF-treated coils appear to provide some incremental benefit in ease of extraction over conventional, nontreated coil ICD leads. Although many current ICD leads do not have fibrosis ingrowth-limiting strategies, our study may rationalize the consideration of adding such technologies to future leads.

Keywords: Lead extraction, Implantable cardioverter-defibrillators, Coated defibrillator leads, Outcomes, Complications

Abbreviations: ePTFE, expanded polytetrafluoroethylene, MABF, medical adhesive back-filled, ICD, implantable cardioverter-defibrillator, NYHA, New York Heart Association, Fr, French, OR, odds ratio, Gy, gray

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 Supported by National Institutes of Health/National Heart, Lung and Blood Institute grant no. R01 HL090620 (to MKC). BDL participates in industry-sponsored research with Medtronic, Boston Scientific, St. Jude Medical, and Biotronik. BLW participates in industry-sponsored research with Medtronic, Boston Scientific, St. Jude Medical, Biotronik, and Spectranetics; and he receives modest consulting fees from Medtronic, St. Jude Medical, Boston Scientific, and Spectranetics and significant consulting fees from LifeWatch. MJN participates in industry-sponsored research with Medtronic, Boston Scientific, St. Jude Medical, Biotronik, and Zoll and has received honoraria from Zoll. PJT participates in industry-sponsored research with Medtronic, Boston Scientific, St. Jude Medical, and Biotronik. MKC participates in industry-sponsored research with Medtronic, Boston Scientific, St. Jude Medical, and Biotronik. The content is solely the responsibility of the authors and does not reflect the views of the funding agencies.

PII: S1547-5271(10)00395-4

doi:10.1016/j.hrthm.2010.04.020

Heart Rhythm
Volume 7, Issue 7 , Pages 890-897, July 2010

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