August 2012

The Chamber

Emory Healthcare Electrophysiologists Take the Lead in Lead Management

Recent years have witnessed explosive growth in the utilization of implantable cardiac defibrillators (ICDs), pacemakers and other heart failure devices. As more patients live longer with more implanted leads, the issue of management of these chronically implanted devices has become a greater clinical concern. The number of transvenous lead extractions that need to be performed annually continues to increase. With four million cardiac rhythm management (CRM) devices in patients worldwide; seven million leads worldwide; and 700,000 new devices and 1.4 million new leads implanted annually; there is a growing need to provide a comprehensive lead management program. There is a 5% (and growing) estimated annual incidence of leads that need to be removed for a variety of reasons, including:
Infection: All implanted leads are susceptible to infection, and this risk is higher in patients with common comorbidities such as diabetes and heart failure, patients requiring dialysis, patients who must undergo other surgeries, and following system modifications such as pulse generator replacement.
Lead Malfunction: Typically, leads represent the weak link in the implanted pacemaker or defibrillator system. While pulse generators are designed with a limited lifespan, leads are expected to last for the life of the patient. Unfortunately, with more leads per patient, more complex leads and patients with longer-than-normal lifespans, eventual lead failure should be anticipated for most patients.
Lead Recalls: Due to demands placed on chronically implanted leads, unexpected design problems do arise. Recent years have seen two major ICD lead recalls encompassing thousands of patients, some of whom required faulty product extraction. Read More