Detection of high incidence of Riata lead breaches by systematic postero-anterior and lateral chest X-ray in a large cohort

作者：Steinberg Christian; Sarrazin Jean Francois^*; Philippon Francois; Bouchard Marc Andre; O'Hara Gilles; Molin Franck; Nault Isabelle; Blier Louis; Champagne Jean

来源：Europace, 2013, 15(3): 402-408.

DOI：10.1093/europace/eus339

• Riata
• Insulation defects
• Defibrillator
• ICD
• Chest X-ray

Aims Insulation breaches with externalization of conductor cables have been described for St-Jude Medical Riata (TM) defibrillation leads. Published data on the incidence of Riata lead abnormalities are quite heterogeneous. The objective of this study was to estimate systematically the prevalence of lead abnormalities using a postero-anterior (PA) and lateral chest X-ray (CXR).
Methods and results From 2002 to 2008, 552 Riata defibrillation leads were implanted at our centre. We evaluated patients for potential insulation breaches. A PA and lateral CXR was obtained. Chest X-rays were reviewed by two electrophysiologists using a zooming function with magnification up to factor 7.5 and were classified as normal or abnormal for the presence of conductor externalization. A total of 284 patients were included. Riata lead models were 1570, 1580, 1582, 1590, 1592, 7000, 7002, and 7022. The total frequency of radiological lead defects was 24.3%. Insulation breaches occurred at zones of major lead curvature. Mean maximal spacing between extruding lead components was 3.6 +/- 1.9 mm (range 2.0-12.4). Abnormal CXRs were more frequent in 8F leads (31.4% vs. 6.3%; P < 0.001). Most defects occurred with lead models 1582 (41.2%) and 1580 (31.4%). Mean time since implantation was longer in abnormal leads (6.7 vs. 5.9 years; P < 0.001). Abnormal leads had higher pacing thresholds (1.1 +/- 0.8 V vs. 0.9 +/- 0.4 V; P = 0.02).
Conclusion The incidence of insulation breach in Riata leads is much higher than quoted by the manufacturer or reported by most of the literature. A PA and lateral CXR with zooming appears adequate to identify lead breaches when reviewed by an electrophysiologist. Riata lead breaches without electrical abnormalities present a management dilemma and will require further studies.

• 出版日期2013-3