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Externalized conductors and insulation failure in biotronik defibrillator leads: History repeating or a false alarm?

引用

World Journal of Clinical Cases 2017年第2期5卷 27-34页

作者： Elia De Maria Ambra Borghi Lorenzo Bonetti Pier Luigi Fontana Stefano Cappelli Cardiology Unit Ramazzini Hospital

Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.

关键词： Implantable cardioverter defibrillator biotronik implantable cardioverter defibrillator lead Externalized conductors Insulation failure

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