Author + information
- Received April 22, 2019
- Revision received June 26, 2019
- Accepted July 1, 2019
- Published online August 28, 2019.
- Wael Alqarawi, MDa,
- Julia Coppens, BMBSa,
- Wafa Aldawood, MDa,
- F. Daniel Ramirez, MDa,
- Calum J. Redpath, MBChB, PhDa,
- Girish M. Nair, MBBS, MSca,
- Pablo B. Nery, MDa,
- Darryl R. Davis, MDa,
- Raed Abu Shama, MDb,
- Alper Aydin, MDa,
- Andres Klein, MDa,
- Mehrdad Golian, MDa,
- Robert D. Schaller, DOc,
- Martin S. Green, MD, FACCa,
- David H. Birnie, MBChB, MDa,∗ and
- Mouhannad M. Sadek, MDa,∗∗ ()
- aArrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
- bCardiology Department, Health Sciences North, Northern Ontario School of Medicine, Laurentian University, Sudbury, Canada
- cSection of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Mouhannad M. Sadek, The Ottawa Hospital - General Campus, Box 703, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Objectives The study sought to examine outcomes of our approach to managing a large cohort of patients with Sprint Fidelis (Medtronic, Minneapolis, Minnesota) leads.
Background The optimal management approach for patients with leads under advisory is unknown. Concerns regarding the risk of device infection and complications associated with delaying lead extraction have recently been suggested to argue against abandoning leads under advisory.
Methods All patients with a Sprint Fidelis lead implanted at our institute were included. Lead management options were discussed with patients who presented for device surgery at the time of device upgrade, lead fracture, or elective replacement indicator. Implantation of a new lead with abandonment of the Sprint Fidelis lead was the recommended strategy. Patients were subsequently followed at the device clinic at 6-month intervals and were enrolled prospectively in a longitudinal registry.
Results A total of 520 patients had Sprint Fidelis leads implanted between December 2003 and October 2007 at the study center; 217 patients underwent lead replacement (213 underwent a lead abandonment strategy and 4 underwent a lead extraction strategy). Mean follow-up after lead replacement was 55 ± 33 months. In patients undergoing lead abandonment, 10 of 213 (4.7%) had a procedural complication and 3 of 213 (1.4%) developed subsequent device infection requiring system extraction.
Conclusions In patients with a Sprint Fidelis lead, implanting a new lead without prophylactic extraction may be a feasible and safe strategy but requires longer follow-up.
↵∗ Drs. Birnie and Sadek contributed equally to this work.
Dr. Birnie has served as a consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 22, 2019.
- Revision received June 26, 2019.
- Accepted July 1, 2019.
- 2019 American College of Cardiology Foundation
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