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ICD Lead Failure Management — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyICD Lead Failure ManagementEECC

A 55-year-old man with an ICD for primary prevention HFrEF develops lead failure (fracture identified on CXR with increased impedance on device interrogation). The lead is 8 years old. What are the options for managing a fractured ICD lead?

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Correct answer: A — Options include: percutaneous lead extraction (preferred if feasible — removes the failed lead entirely), adding a new lead alongside the failed one (capping the fractured lead), or tunnelled replacement; decision depends on patient factors, venous access, number of existing leads, and extraction centre expertise

ICD lead failure (fracture, insulation breach) is a significant long-term complication (~5-10% over 10 years). Management options: (1) Percutaneous transvenous lead extraction (TLE): preferred when feasible — removes the fractured lead using specialised extraction tools (laser/mechanical sheaths). Should be performed at experienced extraction centres (procedural risk includes vascular injury, cardiac perforation — ~1-2% major complication rate); (2) Lead abandonment + new lead addition: capping the fractured lead and placing a new lead through the same or contralateral vein. Simpler but adds hardware, increasing future vascular occlusion and infection risk; (3) Tunnelled lead from contralateral side. The 2022 ESC VA/SCD Guidelines recommend lead extraction over abandonment when feasible, particularly in younger patients and those with infected leads. The decision is individualised by the heart rhythm team.

Reference: ESC (2022): VA/SCD Guidelines; EHRA Lead Management Consensus