Safety of Lead Repair Compared to Lead Revision for Visible Lead Insulation Defects in Patients with Cardiac Implantable Electronic Devices.

Abstract Background Cardiac implantable electronic devices deliver life-sustaining therapy and may be prone to hardware degeneration over time. Functioning transvenous endocardial lead with visible insulation breaks are amenable to lead revision (LRV) or lead repair (LRP), with medical adhesive. The latter being a less invasive, and more cost-effective strategy. However, a paucity of data exists on the overall safety of such an approach. Methods This is a retrospective cohort study of patients with lead insulation defects managed either by LRV or LRP with medical adhesive. Data were analyzed from January 2010 to January 2021. All-cause mortality, and both early and late complications were ascertained for all cases. Results A total of 57 cases were identified with a mean age(SD) of 75(±11.8) years; 18(31.6%) were females. A total of 35 (62.5%) patients underwent LRV for an insulation defect and 21(37.5%) underwent LRP. There was no statistical difference in the rate of early and late complications between the two groups over a mean follow-up period of 1.15(±0.78) years (3[8%] LRV vs 1[5%] LRP, P=0.88). One death was identified in each group, not related to the device or device-related procedure. There was no association between device type and the likelihood of LRP versus LRV as an attempted strategy (X2=2.25, P=0.53). Conclusion The results of this study suggest that that the use of a lead repair strategy with silicone adhesive glue and an anchoring sleeve is not associated with an increased rate of early or late complications compared to lead revision in the management of visible lead insulation defects with stable lead function.