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【medical-news】ICD 导线故障率随时间推移而增加
1 May 2007
MedWire News: The likelihood of implantable cardioverter defibrillator (ICD) lead failure increases over time, reaching an annual rate of 20% by 10 years, results of a long-term follow-up study show.
The findings also reveal that more modern leads fail sooner than older models.
“This is somewhat surprising,” commented lead author Thomas Kleeman (Herzzentrum Ludwigshafen, Germany). Older leads that used polyurethane as an insulator were problematic, so silicone was introduced as an alternative in 1997, he explained. “But it seems that the silicone-coated wires have problems even earlier.”
Writing in an advance publication by the journal Circulation, Kleeman and colleagues note that the reliability of defibrillator leads is of increasing concern as the number of patients with long follow-up after ICD implantation continues to grow.
The researchers assessed the annual rate of lead defects in 990 patients who were implanted with a first ICD at their institute between 1992 and 2005. Lead defects were defined as a severe lead failure that required surgical correction, indicated by oversensing unrelated to the cardiac cycle, lead impedance out of the normal range, fracture observed on X-ray, or evidence of lead failure during electrical testing.
A total of 148 (15%) patients experienced a lead defect, and the median time to lead failure was 1704 days (4.7 years).
Patients with lead defects were on average 3 years younger than those without, were more often women (28% vs 19%), and had better-preserved left ventricular (LV) function (LV ejection fraction >40% in 30% vs 24%).
“[These] people have a longer survival so they are affected more often by a lead defect,” Kleeman noted.
The estimated lead survival rates at 5 and 8 years after implantation were 85% and 60%, respectively. The annual failure rate increased with progressive time after implantation and reached 20% in 10-year-old leads.
When the researchers compared 5-year survival of leads implanted after 1997 with those implanted before this time, they found that the newer leads were prone to fail earlier, with rates of 80% versus 93%.
The major cause of lead failure in both groups was insulation defects (56% of older and 46% of newer lead failures).
The authors acknowledge that their findings come from just one center, and that surgeons implanted most leads via the subclavian vein, a procedure associated with higher complication rates.
Nonetheless, Kleeman said: “Lead defect is a very important problem in ICD treatments. The high incidence of lead complications in these patients should be taken into consideration at the time of implantation when deciding about the selection of device or mode of surgical approach for lead implantation.”
Furthermore, he noted that patients with longer follow-up should “have increased surveillance.”
Circulation 2007; Advance online publication
http://www.incirculation.net/NewsItem/ICD-lead-failure-rates-increase-over-time.aspx 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 ICD lead failure rates increase over time
ICD 导线故障率随时间推移而增加
MedWire News: The likelihood of implantable cardioverter defibrillator (ICD) lead failure increases over time, reaching an annual rate of 20% by 10 years, results of a long-term follow-up study show.
10年的长期随访的结果表明，埋藏式复律除颤器（ICD）导线故障率随时间推移而增加，正以每年20%的速度增长。
The findings also reveal that more modern leads fail sooner than older models.
这项发现表明更多的新式的ICD导线比老式的ICD导线更早的发生故障
“This is somewhat surprising,” commented lead author Thomas Kleeman (Herzzentrum Ludwigshafen, Germany). Older leads that used polyurethane as an insulator were problematic, so silicone was introduced as an alternative in 1997, he explained. “But it seems that the silicone-coated wires have problems even earlier.”
“这多少让人有些吃惊”，托马斯.克里门（德国）评论到。"老式的ICD导线采
用聚氨基甲酸酯作为导线绝缘材料是令人质疑的，因此硅酮在1997年引入作为替代材料",他解释道,"但是看起来包被硅酮的导线却更早的出现了故障".
Writing in an advance publication by the journal Circulation, Kleeman and colleagues note that the reliability of defibrillator leads is of increasing concern as the number of patients with long follow-up after ICD implantation continues to grow.
克里门和 他的 同事在发表在循环杂志中提到,长期的随访发现,在植入ICD的患者中,对于ICD导线可靠性的担忧在不断增加.
The researchers assessed the annual rate of lead defects in 990 patients who were implanted with a first ICD at their institute between 1992 and 2005. Lead defects were defined as a severe lead failure that required surgical correction, indicated by oversensing unrelated to the cardiac cycle, lead impedance out of the normal range, fracture observed on X-ray, or evidence of lead failure during electrical testing.
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作者:admin@医学,生命科学 2010-10-15 17:11
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