Multicenter Experience With Extraction of the Sprint Fidelis Implantable Cardioverter-Defibrillator Lead

doi:10.1016/j.jacc.2010.03.058

Journal of the American College of Cardiology

Volume 56, Issue 8, 17 August 2010, Pages 646-650

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Objectives

This study was undertaken to determine the safety and feasibility of extraction of the Sprint Fidelis (Medtronic, Minneapolis, Minnesota) lead.

Background

The reported failure rate of the Sprint Fidelis defibrillator lead has increased to a range greater than initially appreciated with emerging evidence of an accelerating rate of fracture. At present, consensus guidelines continue to recommend against prophylactic extraction of the lead, citing major complication rates between 1.4% and 7.3%. However, data regarding the safety and feasibility of extraction of small-diameter, backfilled implantable cardioverter-defibrillator leads such as the Sprint Fidelis are limited.

Methods

We performed a retrospective cohort study of consecutive patients undergoing extraction of Sprint Fidelis (models 6930, 6931, 6948, 6949) leads at 5 high-volume centers. Patient characteristics, indications for extraction, and use of countertraction sheath (CTS) assistance are reported. The risk of major and minor complications was determined. A multivariable logistic regression model was developed to predict factors associated with the use of CTS assistance.

Results

Between May 2005 and August 2009, 349 Sprint Fidelis leads were extracted from 348 patients. All leads were removed completely. The average duration of the implanted lead was 27.5 months (range 0.03 to 58.8 months). Approximately one-half of the extracted leads were fractured (49.4%), and 26.5% were extracted prophylactically. The other major indication for extraction was infection (22.8%). Extraction was achieved with simple traction in 49.4% leads; CTS assistance was required in 174 cases (50.6%). In multivariable models, length of time since implantation was directly related to the need for CTS assistance (odds ratio per month since implantation: 1.035; 95% confidence interval: 1.010 to 1.061; p = 0.006). There were no major procedural complications or deaths.

Conclusions

Extraction of the Sprint Fidelis lead can be performed safely by experienced operators at high-volume centers with a complication rate lower than that reported for older generation leads. However, leads with longer implant durations are associated with the use of CTS assistance. Recommendations regarding prophylactic Sprint Fidelis lead extraction may warrant reconsideration.

Key Words

implantable cardioverter-defibrillator

lead extraction

lead management

Abbreviations and Acronyms

CTS

countertraction sheath assistance

ICD

implantable cardioverter-defibrillator

IQR

interquartile range

Cited by (0)

: Dr. Love has received research grants from Biotronik, Boston Scientific, Medtronic, and St. Jude Medical, and is a consultant for Biotronik, Boston Scientific, Cook Vascular, Medtronic, Sorin/ELA, St. Jude Medical, Spectranetics, WL Gore, QRS Systems, and TyRx. Dr. Fischer is a consultant for/receives honoraria from Boston Scientific, Medtronic, Spectranetics, and St. Jude Medical. Dr. Carrillo is a consultant for Medtronic, Sorin/ELA, Spectranetics, and St. Jude Medical. Dr. John is a consultant for Boston Scientific and St. Jude Medical. Dr. Michaud is a consultant for Biosense-Webster, Medtronic, and St. Jude Medical. Dr. Albert has received research grants from Boston Scientific and St. Jude Medical, and is a consultant for Boston Scientific, Medtronic, and St. Jude Medical. Dr. Epstein has received research grants from and is a consultant for Boston Scientific, Medtronic, Spectranetics, and St. Jude Medical, and has equity in and served as a board member for Carrot Medical. All other authors report that they have no relationships to disclose.