The Leading Cause of Failure

Pacemaker and implantable cardioverter defibrillator development has revolutionized the treatment of many kinds of cardiac diseases. The technology advancements have been tremendous, and once-large external batteries are now replaced by gumstick-sized modules as sophisticated as any computer. Unfortunately, the leads that provide sensing, pacing, and defibrillation represent a vulnerable part of the system, and have short- and long-term failure modes. Failure modes can cause a spectrum of issues from minor annoyances to catastrophic failure and death. Failure usually requires replacement of the generator, leads, or both, which subjects the patient to an additional procedure with its own associated complications.   Failure modes include acute perforation, dislodgement, infection, vein thrombosis, migration, conduction failure, insulation damage, and wire externalization.   Silicone Casing Structural Failure: Insulation failure has been seen in several lead designs. The silicone casing around transvenous leads is subjected to conditions that can lead to fracture and structural failure. The proximal length undergoes high muscular stress from the pectoral muscles. It can also be crushed because it’s above the bony thorax wall, causing lead-to-lead or lead-to-can disruption. The distal segment experiences high intracardiac forces and dynamic flexing. There are also fatigue initiation points where the shocking coil is attached to the silicone. The most common site of failure is...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs