Background: Implantable cardioverter defibrillators (ICD) are widely used in clinical practice and have demonstrated to be beneficial for primary and secondary prevention of sudden cardiac death. However, lead-related complications such as lead fracture or insulation defects leading to inappropriate shocks are a major problem for ICD patients since they are common and associated with increased morbidity and mortality.

Purpose: The goal of our study was to investigate the presentation of ICD lead defects regarding inappropriate ICD shocks between different brands.

Methods: We retrospectively analyzed all defects in chronic implanted leads in our hospital occurring from 2013 to 2016. Acute lead dislocations were excluded from our analysis.

Results: In total, 55 lead defects occurred from 2013 to 2016 in our hospital including 22 leads from Medtronic, 22 from Biotronik, 8 from St. Jude Medical, 2 from Boston Scientific. 9/22 defect Medtronic leads were Sprint Fidelis leads, 20/22 defect Biotronik leads were Linox Smart leads, and 8/8 defect St. Jude Medical leads were Durata leads.

The average lead survival was 6.7±2.7 years for Medtronic leads, 3.8±2.4 years for Biotronik leads, 3.5±1.5 years for St. Jude Medical leads, 10.1±6.3 years for Boston Scientific leads (Figure 1A).

In 13 patients (24%) inappropriate shocks occurred (2/22, 8/22, 3/8, 0/2, for Medtronic, Biotronik, St. Jude Medical, Boston Scientific, respectively). The average number of inappropriate shocks was 1 for Medtronic, 16.5 for Biotronik and 6.3 for St. Jude Medical leads (Figure 1B).

Patient alert occurred in 9/22 Medtronic lead defects and in 1/8 St. Jude Medical lead defects. Alerts during home monitoring occurred in 1/22 Medtronic lead defects and in 6/22 Biotronik lead defects. Inappropriate shocks occurred in 1/8 Biotronik lead defects despite an alert during home monitoring. No inappropriate shock occurred when patients were notified through a patient alert.

In our cohort, the number of inappropriate ICD shocks in patients with ICD lead defect vary significantly between different brands. Device implemented algorithms or home monitoring can significantly reduce the number of inappropriate shocks and therefore reduce patient harm caused by lead failure.