From the Research
Approximately 6.5% of patients experience an Implantable Cardioverter-Defibrillator (ICD) wire shift after implantation, as reported in a study published in the Journal of Cardiovascular Electrophysiology 1. This complication, also known as lead dislodgement or migration, typically occurs within the first few weeks to months following the procedure. The mechanisms of lead dysfunction include macrodislodgement, surgical lead injury, recall, insulation failure, conductor fracture, and alterations in the lead-myocardial interface. When a wire shift occurs, patients may experience inappropriate shocks, failure to deliver therapy when needed, or changes in sensing and pacing thresholds. Symptoms that might indicate a wire shift include hiccups, muscle twitching in the chest or diaphragm area, or audible clicking sounds from the device. If suspected, patients should contact their cardiologist immediately for evaluation, which typically involves a chest X-ray and device interrogation. Most wire shifts require a revision procedure to reposition or replace the affected lead to ensure proper device function and patient safety. Some key points to consider:
- The incidence of right ventricular lead dysfunction following LVAD implantation is significant and has important clinical sequelae 1.
- Lead monitoring alerts had 100% sensitivity for identifying lead failures, although their positive predictive value was modest 2.
- Clinical performance of ICD lead monitoring diagnostics is crucial in identifying lead failures and preventing inappropriate shocks 2.
- Isolated subcutaneous ICD generator displacement can cause inappropriate shocks despite preserved lead tip and coil position 3.
- Early diagnosis of defibrillation lead dislodgement is essential to prevent inappropriate shocks and fatal outcomes 4.