Charles Swerdlow, MD, FHR

Cedars S ina i Medic

Dis c los ures

Cons ulting Fe e s /Hono

Re s e a rch Gra nts : Me d

;

P e ric a rd ia l e ffu s io n

Le a d d g e m e n t

1. Jordan M. Prutkin et a l. Circula tion.2. Unsworth JD et a l , Europace 20153.Greenspon AJ et a l., J Am Coll Card4. Tarakji et a l; Europace , 2014;16:1495. Maytin et a l; Circ Arrhythm Electroph

No incre a s e d ris k in he modia ly

1. Burke , M.C. e t a l. J Am Coll Cardiol, 22. Koman e t a l, J Inte rv Card Electrophy3. El-Chami et a l JCE 29 April 2015

High load, low cycle Low load, high cycle

Forc e s Ap p lie d to Tra n s ve n ou s Le a ds :Im p lic a tio ns fo r Le a d Re lia b ility a n d Fa ilu re

Helical

Screw

Explant damage of PU

outer tubing

Helix on stylet. Fractured ends

separated due to tension

Silicone Cold Flow (Creep)

ETFE

SEM x 30

Suture

Suture

He lix Fa ilure a t Ve nous Ins e rtion S iteSwerdlow et al. JACC2016;67:1358-1368

Liu J. Longitudinal follow-up of impla

*

Recalled

from unre lia ble

le a ds e a rly?

Daubert JP , e t a l. JACC 2008; 51:1357-1365.Volosin KJ, e t a l. J Cardiovasc Electrophysiol 20Auricchio A, et a l. Heart Rhythm, online before p

Improved T-wave )

Rare ly, new IVCD

Need for Pacingor ATP

TV-ICD LCP + S -ICD

(modula r)

*Gold e t a l. APHRS 2016; † Moss A et

Cathe te r-DeliveredLeadless CapsulePacemaker (LCP)

+ S-ICD

Clinical Implant Swine Experiment

Lower DFT (~ 15 v

Improved sens ing

Pacing ~ 90% of a

No (? ) need for EC

SubSte rna l vs . Sub

Subs te rna lLead P te ra l

young/active

⬆ risk of sys tem infection

Previous CIED infection or ba

Valve rep

? Hemod

Life expe

Genetic d(LQTS, Brug

Sub cuta ne ous -ICD Advantages

No in travas cu lar implan(e .g . pneumothorax)

No in travas cu lar mechacomplica tions (e .g . tric

No in travas cu lar s ys tem

Greater lead re liab ility (

Lead extrac tion s imple/

Sub cuta ne ous -ICD Advantages

No in travas cu lar implan(e .g . pneumothorax)

No in travas cu lar mechacomplica tions (e .g . tric

No in travas cu lar s ys tem

Greater lead re liab ility (

Lead extrac tion s imple /

High load, low cycle Low load, high cycle

Forces Applied to Transvenous Leads