Failures of epicardial and transvenous leads for implantable cardioverter defibrillators.

Lead failures constitute a major risk for patients with an implantable cardioverter defibrillator (ICD). However, data about the incidence and patterns of ICD-lead failures in a larger population are lacking. We analyzed the short-term and midterm performance of 27 epicardial and 103 nonthoracotomy ICD-lead systems during a follow-up period of 36 +/- 21 months and 22 +/- 10 months, respectively (p < 0.05). The failure rate was 5 (19%) of 27 in the epicardial and 6 (6%) of 103 in the nonthoracotomy group (p < 0.05). The most common symptom was erroneous detection of ventricular fibrillation from artifact sensing in five patients. Two patients had to be resuscitated because of failure to defibrillate. Loss of pacing and loss of sensing were seen in two patients. Only two asymptomatic lead fractures could be diagnosed on routine radiograph. In conclusion, there was a considerable rate of lead failures, especially in epicardial systems. Long-term studies addressing the longevity of ICD leads, mechanisms of their failures, and improved diagnostic facilities are important to further increase the safety of this therapeutic approach.