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What physicians do in case of a failure of the pace-sense part of a defibrillation lead

Survey in Germany, Austria and Switzerland

Was Ärzte bei Versagen des Pace-Sense Anteils von Defibrillationselektroden tun

Eine Umfrage in Deutschland, Österreich und der Schweiz

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Abstract

Background

The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead.

Methods

We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers.

Results

The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation.

Conclusion

Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.

Zusammenfassung

Hintergrund

Als Behandlungsstrategie bei Defekten des Pace-Sense(P/S)-Anteils einer Defibrillationselektrode sind entweder die Implantation einer neuen High-Voltage(HV)-P/S-Elektrode – mit oder ohne Extraktion der defekten Elektrode – oder die Implantation einer P/S-Elektrode möglich.

Methoden

Die Autoren führten eine webbasierte Erhebung in Zentren durch, in denen eine Therapie mit kardialen implantierbaren elektronischen Systemen („cardiac implantable electronic device“, CIED) erfolgt, um deren praktische Abläufe und Entscheidungsprozesse in Fällen mit einer Dysfunktion des P/S-Anteils von Defibrillationselektroden zu untersuchen. Insbesondere lag der Schwerpunkt auf der Frage, ob die Integrität des HV-Stromkreislaufs vor dem Treffen einer Entscheidung durch einen Testschock bestätigt würde. Der Fragebogen beinhaltete 14 Fragen und wurde 951 deutschen, 341 österreichischen und 120 Schweizer Zentren zugeschickt.

Ergebnisse

Die Umfrage wurde von 183 der 1412 angeschriebenen Zentren beantwortet (12,7 % Antwortrate). Die meisten Zentren (90,2 %) führen keinen Testschock zur Bestätigung der Integrität des HV-Stromkreislaufs vor dem Treffen einer Entscheidung durch. Die praktischen Abläufe im Hinblick auf die medizinische Versorgung variieren je nach entsprechender Ausprägung der Elektrodendysfunktion und abhängig davon, ob das jeweilige Zentrum mit einem Testschock arbeitet. In Zentren, die keinen Testschock geben, implantiert die Mehrheit (69,9 %) eine neue HV-P/S-Elektrode. Die meisten Zentren (61,7 %), welche die Integrität des HV-Systems prüfen, implantieren eine P/S-Elektrode. Die Mehrheit der Zentren bevorzugt DF-4-Konnektoren (74,1 %) vor DF-1-Konnektoren (25,9 %) bei der ersten CIED-Implantation.

Schlussfolgerung

Die Implantation einer neuen HV-P/S-Elektrode oder die Platzierung einer zusätzlichen P/S-Elektrode stellen die ausgewählten Strategien dar, wenn das Versagen der ICD-Elektroden im P/S-Anteil lokalisiert ist. Jedoch wird nur selten ein Testschock zur Bestätigung der Integrität der HV-Komponente gegeben.

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Authors and Affiliations

  1. Department of Cardiology, Charité—Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    P. Lacour, A. Parwani, M. Huemer, P. Attanasio, P. L. Dang, J. Luebcke, L. Schleussner, D. Blaschke, L.-H. Boldt, B. Pieske, W. Haverkamp &  F. Blaschke

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  1. P. Lacour
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  2. A. Parwani
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  3. M. Huemer
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  4. P. Attanasio
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Correspondence to F. Blaschke.

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Conflict of interest

P. Lacour, A. Parwani, M. Huemer, P. Attanasio, P.L. Dang, J. Luebcke, L. Schleussner, D. Blaschke, L.-H. Boldt, B. Pieske, W. Haverkamp, and F. Blaschke declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Lacour, P., Parwani, A., Huemer, M. et al. What physicians do in case of a failure of the pace-sense part of a defibrillation lead. Herz 45, 362–368 (2020). https://doi.org/10.1007/s00059-018-4736-9

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  • DOI: https://doi.org/10.1007/s00059-018-4736-9

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