Skip to main content

Importance of Knowing Lead and Patient Interaction

  • Chapter
  • 737 Accesses

Abstract

The implantable cardiac pacemaker (PM)/defibrillator is a technically sophisticated system composed of a generator connected to one or more leads. Pacemaker/defibrillator leads play a pivotal role for system function, delivering the output pulse or the endocardial shock from the generator to the myocardium and acquiring spontaneous intracardiac electrogram from the heart to the device. Leads are also the most frequently involved component in case of system malfunction, and when a generator-pocket infection is present, their extraction — always necessary to guarantee complete resolution — is a challenge. The success of lead extraction is highly influenced by lead characteristics; for that reason, this chapter is dedicated to lead technology, i.e., polarity, electrodes, fixation mechanisms, electrode-tissue interaction, conductors, insulators, and connectors, with particular attention to aspects that may interfere with the extraction procedure. We discuss separately cardiac PM and defibrillator leads to emphasize their different technology.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Cuvillier E (2009) Handbook of leads for pacing, defibrillation & cardiac resynchronization. Eric Cuvillier, Juana Dìaz

    Google Scholar 

  2. Barold SS, Stroobant RX, Sinnaewe AF (2004) Cardiac pacemaker step by step — an illustrated guide. Blackwell, Malden

    Book  Google Scholar 

  3. Amundson DC, McArthur W, Mosharrafa M (1979) The porous endocardial electrode. Pacing Clin Electrophysiol 2(1):40–50

    Article  PubMed  CAS  Google Scholar 

  4. MacCarter DJ, Lundberg KM, Corstjens JP (1983) Porous electrodes: concept technology and results. Pacing Clin Electrophysiol 6(2 Pt 2): 427–435

    Article  PubMed  CAS  Google Scholar 

  5. Skalsky M, Maddison D (1985) Evaluation of a new low polarisation high impedence Pt/Ir coated porous 6 mm 2 dish electrode. Pacing Clin Electrophysiol 8:788 [abstract]

    Google Scholar 

  6. Garberoglio B, Inguaggiato B, Chinaglia B, Cerise O (1983) Initial results with an activated pyrolytic carbon tip electrode. Pacing Clin Electrophysiol 6(2 Pt 2): 440–448

    Article  PubMed  CAS  Google Scholar 

  7. Mugica J, Henry L, Attuel P et al (1986) Clinical experience with 910 carbon tip leads: comparison with polished platinum leads. Pacing Clin Electrophysiol 9(2 Pt 2):1230–1238

    Article  PubMed  CAS  Google Scholar 

  8. Thuesen L, Jensen PJ, Vejby-Christensen H et al (1989) Lower chronic stimulation threshold in the carbon-tip than in the platinum-tip endocardial electrode: a randomized study. Pacing Clin Electrophysiol 12(10):1592–1595

    Article  PubMed  CAS  Google Scholar 

  9. Mond H, Hunt D (1990) A second generation steroid eluting electrode Cardiostim 90. RBM Seventh International Congress Nice 12:62

    Google Scholar 

  10. Danilovic D, Breivik K, Hoff PI, Ohm OJ (1997) Clinical performance of steroid-eluting pacing leads with 12-mm2 electrodes. Pacing Clin Electrophysiol 20(11):2799–2809

    Article  PubMed  CAS  Google Scholar 

  11. Hua W, Mond HG, Strathmore N (1997) Chronic steroideluting lead performance: a comparison of atrial and ventricular pacing. Pacing Clin Electrophysiol 20(1 Pt 1):17–24

    Article  PubMed  CAS  Google Scholar 

  12. Jenney C, Tan J, Karicherla A et al (2005) A new insulation material for cardiac leads with potential for improved performance. Heart Rhythm 2:S318–S319

    Article  Google Scholar 

  13. Calfee RV, Saulson SH (1986) A voluntary standard for 32 mm unipolar and bipolar pacemaker leads and connectors. Pacing Clin Electrophysiol 9(6 Pt 2):1181–1185

    Article  PubMed  CAS  Google Scholar 

  14. Mirowski M, Reid PR, Mower MM et al (1980) Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 303(6):322–324

    Article  PubMed  CAS  Google Scholar 

  15. Haqqani HM, Mond HG (2009) The implantable cardioverter-defibrillator lead: principles, progress, and promises. Pacing Clin Electrophysiol 32:1336–1353

    Article  PubMed  Google Scholar 

  16. Wilkoff BL, Belott PH, Love CJ et al (2005) Improved extraction of ePTFE and medical adhesive modified defibrillation leads from the coronary sinus and great cardiac vein. Pacing Clin Electrophysiol 28(3):205–211

    Article  PubMed  Google Scholar 

  17. Kouht AR, Grammes J (2009) The ePTFE coated ICD leads are easier to remove than standard ICD leads up to 50 months implant duration. Hearth Rhythm 6(5):S132 [abstract]

    Google Scholar 

  18. Di Cori A, Bongiorni MG, Zucchelli G et al (2010) Transvenous extraction performance of expanded polytetrafluoroethylene-covered ICD leads in comparison to traditional ICD leads in humans. Pacing Clin Electrophysiol [Epub ahead of print]

    Google Scholar 

  19. Helland J, St Jude Medical Personal communication

    Google Scholar 

  20. Hauser RG, Cannom D, Hayes DL et al (2002) Long-term structural failure of coaxial polyurethane implantable cardioverter defibrillator leads, Pacing Clin Electrophysiol 25(6):879–882

    Article  PubMed  Google Scholar 

  21. Krahn AD, Champagne J, Healey JS et al (2008) Outcome of the Fidelis implantable cardioverter-defibrillator lead advisory: a report from the Canadian Heart Rhythm Society Device Advisory Committee. Heart Rhythm 5(5):639–642

    Article  PubMed  Google Scholar 

  22. Epstein AE, Baker JH 2nd, Beau SL et al (2009) Performance of the St Jude Medical Riata leads. Heart Rhythm 2009 6(2):204–209

    Article  PubMed  Google Scholar 

  23. Kay GN, Brinker JA, Kawanishi DT et al (1999) Risks of spontaneous injury and extraction of an active fixation pacemaker lead: report of the Accufix Multicenter Clinical Study and Worldwide Registry. Circulation 100(23):2344–2352

    Article  PubMed  CAS  Google Scholar 

  24. Fortescue EB, Berul CI, Cecchin F et al (2004) Patient procedural and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm 1(2):150–159

    Article  PubMed  Google Scholar 

  25. Ellenbogen KA, Wood MA, Shepard RK et al (2003) Detection and management of an implantable cardioverter defibrillator lead failure: incidence and clinical implications. J Am Coll Cardiol 41(1):73–80

    Article  PubMed  Google Scholar 

  26. Knight BP, Desai A, Coman J et al (2004) Long-term retention of cardiac resynchronization therapy. J Am Coll Cardiol 44(1):72–77

    Article  PubMed  Google Scholar 

  27. Bongiorni MG, DI Cori A, Zucchelli G et al (2010) A modified transvenous single mechanical dilatation technique to remove a chronically implanted active-fixation coronary sinus pacing lead. Pacing Clin Electrophysiol [Epub ahead of print]

    Google Scholar 

  28. Holmes DR Jr (1986) Permanent pacemaker implantation. In: Furman S, Hayes DL, Holmes DR Jr (eds) A practice of cardiac pacing. Futura, Mount Kisco, pp 97–127

    Google Scholar 

  29. Ellenbogen KA, Wood MA (2005) Cardiac pacing and ICDs 4th edn, Blackwell

    Google Scholar 

  30. Ellestad MH, French J (1989) Iliac vein approach to permanent pacemaker implantation. Pacing Clin Electrophysiol 12(7 Pt 1):1030–1033

    Article  PubMed  CAS  Google Scholar 

  31. García Guerrero JJ, De La Concha Castañeda JF, Fernández Mora G et al (2005) Permanent transfemoral pacemaker: a single-center series performed with an easier and safer surgical technique. Pacing Clin Electrophysiol 28(7):675–679

    Article  PubMed  Google Scholar 

  32. Kennergren C (2008) European perspective on lead extraction: part II. Heart Rhythm 5(2):320–323

    Article  PubMed  Google Scholar 

  33. Vellani CW, Tildesley G, Davies LG (1969) Endocardial pacing: a percutaneous method using the subclavian vein. Br Heart J 31(1):106–111

    Article  PubMed  CAS  Google Scholar 

  34. Mobin-Uddin K, Smith PE, Lombardo C, Jude J (1967) Percutaneous intracardiac pacing through the subclavian vein. J Thorac Cardiovasc Surg 54(4):545–548

    PubMed  CAS  Google Scholar 

  35. Jachuck SJ, Gill BS, Petty AH. (1974) Permanent cardiac pacing through the subclavian vein. Br J Surg 61(5):373–376

    Article  PubMed  CAS  Google Scholar 

  36. Littleford PO, Spector SD (1979) Device for the rapid insertion of a permanent endocardial pacing electrode through the subclavian vein: preliminary report. Ann Thorac Surg 27(3):265–269

    Article  PubMed  CAS  Google Scholar 

  37. Friesen A, Klein GJ, Kostuk WJ, Ahuja SP (1977) Percutaneous insertion of a permanent transvenous pacemaker electrode through the subclavian vein. Can J Surg 20(2):131–135

    PubMed  CAS  Google Scholar 

  38. Kessinger JM, Holter AR, Geha AS (1982) Implantation of permanent transvenous pacemaker via subclavian vein. Arch Surg 117(8):1105–1107

    Article  PubMed  CAS  Google Scholar 

  39. Vander Salm TJ, Haffajee CI, Okike ON (1981) Transvenous insertion of double sets of permanent electrodes through a single introducer: clinical application. Ann Thorac Surg 32(3):307–310

    Article  Google Scholar 

  40. Bernstein AD, Parsonnet V (1992) Survey of cardiac pacing in the United States in 1989. Am J Cardiol 69(4):331–338

    Article  PubMed  CAS  Google Scholar 

  41. Goldman BS, Fraser JD, Morgan CD (1991) Survey of cardiac pacing in Canada. Can J Cardiol 7(9):391–398

    PubMed  CAS  Google Scholar 

  42. Jacobs DM, Fink AS, Miller RP et al (1993) Anatomical and morphological evaluation of pacemaker lead compression. Pacing Clin Electrophysiol 16(3 Pt 1):434–444

    Article  PubMed  CAS  Google Scholar 

  43. Magney JE, Flynn DM, Parsons JA et al (1993) Anatomical mechanisms explaining damage to pacemaker leads defibrillator leads and failure of central venous catheters adjacent to the sternoclavicular joint. Pacing Clin Electrophysiol 16(3 Pt 1):445–457

    Article  PubMed  CAS  Google Scholar 

  44. Kleemann T, Becker T, Doenges K et al (2007) Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation 115(19):2474–2480

    Article  PubMed  Google Scholar 

  45. Takahashi T, Bhandari AK, Watanuki M et al (2002) High incidence of device-related and lead-related complications in the dual-chamber implantable cardioverter defibrillator compared with the single-chamber version. Circ J 66(8):746–750

    Article  PubMed  Google Scholar 

  46. Smith MC, Love CJ (2008) Extraction of transvenous pacing and ICD leads. Pacing Clin Electrophysiol 31(6):736–752

    Article  PubMed  Google Scholar 

  47. Rozmus G, Daubert JP, Huang DT et al (2005) Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol 13(1):9–19

    Article  PubMed  Google Scholar 

  48. Contini C, Papi L, Pesola A et al (1973) Tissue reaction to intracavitary electrodes: effect on duration and efficiency of unipolar pacing in patients with A-V block. J Cardiovasc Surg (Torino) 14(3):282–290

    CAS  Google Scholar 

  49. Pauletti M, Pingitore R, Contini C (1979) Superior vena cava stenosis at site of intersection of two pacing electrodes. Br Heart J 42(4):487–489

    Article  PubMed  CAS  Google Scholar 

  50. Esposito M, Kennergren C, Holmström N et al (2002) Morphologic and immunohistochemical observations of tissues surrounding retrieved transvenous pacemaker leads. J Biomed Mater Res 63(5):548–558

    Article  PubMed  CAS  Google Scholar 

  51. Epstein AE, Kay GN, Plumb VJ et al (1998) Gross and microscopic pathological changes associated with nonthoracotomy implantable defibrillator leads. Circulation 98(15):1517–1524

    Article  PubMed  CAS  Google Scholar 

  52. Byrd CL, Schwartz SJ, Hedin N (1991) Intravascular techniques for extraction of permanent pacemaker leads. J Thorac Cardiovasc Surg 101(6):989–997

    PubMed  CAS  Google Scholar 

  53. Bongiorni MG, Soldati E, Zucchelli G et al (2008) Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads. Eur Heart J 29(23):2886–2893

    Article  PubMed  Google Scholar 

  54. Korkeila P, Nyman K, Ylitalo A et al (2007) Venous obstruction after pacemaker implantation. Pacing Clin Electrophysiol 30(2):199–206

    Article  PubMed  Google Scholar 

  55. Lickfett L, Bitzen A, Arepally A et al (2004) Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace 6(1):25–31

    Article  PubMed  Google Scholar 

  56. Haghjoo M, Nikoo MH, Fazelifar AF et al (2007) Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change lead revision or device upgrade. Europace 9(5):328–332

    Article  PubMed  Google Scholar 

  57. Aryana A, Sobota KD, Esterbrooks DJ, Gelbman AI (2007) Superior vena cava syndrome induced by endocardial defibrillator and pacemaker leads. Am J Cardiol 99(12):1765–1767

    Article  PubMed  Google Scholar 

  58. Melzer C, Lembcke A, Ziemer S et al (2006) Pacemaker-induced superior vena cava syndrome: clinical evaluation of long-term follow-up. Pacing Clin Electrophysiol 29(12):1346–1351

    Article  PubMed  Google Scholar 

  59. van Rooden CJ, Molhoek SG, Rosendaal FR et al (2004) Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. J Cardiovasc Electrophysiol 15(11):1258–1262

    Article  PubMed  Google Scholar 

  60. Sticherling C, Chough SP, Baker RL et al (2001) Prevalence of central venous occlusion in patients with chronic defibrillator leads. Am Heart J 141(5):813–816

    Article  PubMed  CAS  Google Scholar 

  61. Bracke F, Meijer A, Van Gelder B (2003) Venous occlusion of the access vein in patients referred for lead extraction: influence of patient and lead characteristics. Pacing Clin Electrophysiol 26(8):1649–1652

    Article  PubMed  Google Scholar 

  62. Worley SJ, Gohn DC, Pulliam RW (2008) Over the wire lead extraction and focused force venoplasty to regain venous access in a totally occluded subclavian vein. J Interv Card Electrophysiol 23(2):135–137

    Article  PubMed  Google Scholar 

  63. Bakir I, La Meir M, Degrieck I et al (2005) Contralateral replacement of pacemaker and leads following laser sheath extraction and concomitant stenting for superior vena cava syndrome. Pacing Clin Electrophysiol 28(10):1131–1134

    Article  PubMed  Google Scholar 

  64. Gilard M, Pérennes A, Mansourati J et al (2002) Stent implantation for the treatment of superior vena cava syndrome related to pacemaker leads. Europace 4(2):155–158

    Article  PubMed  CAS  Google Scholar 

  65. Worley SJ (2008) Implant venoplasty: dilation of subclavian and coronary veins to facilitate device implantation: indications frequency methods and complications. J Cardiovasc Electrophysiol 19(9):1004–1007

    Article  PubMed  Google Scholar 

  66. Borek PP, Wilkoff BL (2008) Pacemaker and ICD leads: strategies for long-term management. J Interv Card Electrophysiol 23(1):59–72

    Article  PubMed  Google Scholar 

  67. Korley VJ, Hallet N, Daoust M, Epstein LM (2000) A novel indication for transvenous lead extraction: upgrading implantable cardioverter defibrillator systems. J Interv Card Electrophysiol 4(3):523–528

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Italia

About this chapter

Cite this chapter

De Lucia, R., Coluccia, G., Viani, S., Paperini, L. (2011). Importance of Knowing Lead and Patient Interaction. In: Bongiorni, M.G. (eds) Transvenous Lead Extraction. Springer, Milano. https://doi.org/10.1007/978-88-470-1466-4_1

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1466-4_1

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1465-7

  • Online ISBN: 978-88-470-1466-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics