Comparative Outcomes of Transvenous Extraction of Sprint Fidelis and Riata Defibrillator Leads: A Single Center Experience

Abstract

The FDA has issued class I advisories for Medtronic Sprint Fidelis(®) and St. Jude Medical Riata(TM) ICD lead families. Transvenous Riata(TM) ICD lead extraction is typically considered higher risk than Fidelis(®) extraction, based on longer duration from implant, presence of externalized conductors and lack of silicone backfill in the SVC and RV coils. However, published data comparing procedural outcomes between these leads are limited. Records were reviewed for all patients undergoing transvenous extraction of Sprint Fidelis(®) or Riata(TM) ICD leads at the Vanderbilt Heart and Vascular Institute from July 2006 to April 2013 to ascertain indication for extraction, procedural details, complications, and 30-day mortality. There were significant differences between those undergoing extraction of a Sprint Fidelis(®) (n= 145) or Riata(TM) lead (n= 47). In the Riata(TM) group, device-related endocarditis was a more common indication for extraction, the mean duration of implant was longer, and larger excimer laser sheaths were required. Lead malfunction was a more common indication in the Fidelis(®) group. There were no statistically significant differences in median procedure duration, procedural success (97.9% vs 95.7%, P= 0.41), median length of hospital stay (1 day vs 1 day, P= 0.23), procedural complication rate (5.5% vs 10.6%, P= 0.23) or 30-day mortality (2.1% vs 2.1%, P= 0.98). Analyses excluding patients with device infection revealed similar results. Despite differences in baseline characteristics, this study indicates that Medtronic Sprint Fidelis(®) and St. Jude Riata(TM) ICD leads have similar procedural outcomes with transvenous lead extraction.