Safe Extraction of Riata Looped Extruding Filler Cables

Abstract

The Riata 1590 lead model contains both electrically active cables (AC) and filler cables (FC) that run in pairs within lumens along the lead body. FC are yet to be described as lead components that may be externalized from either external abrasion or inside-out abrasion seen in the recalled St. Jude leads. Externalization of FC would not be expected to develop any electrical abnormality during routine ICD and lead evaluations. FC are fixed at their ends only with a silicone adhesive compared to mechanical crimps for AC. This glue bond can break allowing a progressive migration of the filler cable to extrude out the insulation breach forming profound loops of cables. We identify the 10 recalled Riata models that contain the electrically inactive FC that will need closer scrutiny by X-ray imaging techniques. Extraction of ICD leads with externalized cables may be difficult, with the presence of extruded loops of FC compounding procedural complexity. We describe a technique that reduced extruded loops of FC and allowed safe extraction of the lead.