Author + information
- Melanie Maytin, MD⁎ (, )
- Charles J. Love, MD,
- Avi Fischer, MD,
- Roger G. Carrillo, MD,
- Juan D. Garisto, MD,
- Maria Grazia Bongiorni, MD,
- Luca Segreti, MD,
- Roy M. John, MD, PhD,
- Gregory F. Michaud, MD,
- Christine M. Albert, MD, MPH and
- Laurence M. Epstein, MD
- ↵⁎Brigham & Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115
We thank Dr. Martin and colleagues for their interest in our paper (1) and commend the authors on their similarly successful experience with transvenous lead extraction (TLE) of the Medtronic Sprint Fidelis implantable cardioverter-defibrillator (ICD) lead (Medtronic, Minneapolis, Minnesota). Their reported success illustrates that TLE of the Sprint Fidelis ICD lead can be a safe procedure in select patients and experienced hands.
Furthermore, we appreciate the authors' support of our contention that in select patients and experienced hands, the current recommendations regarding Sprint Fidelis ICD lead extraction warrant reconsideration. In fact, our practice regarding the management of the Sprint Fidelis lead at the time of pulse generator replacement is similar to that described by the authors; among patients undergoing pulse generator replacement “who require ongoing defibrillator therapy and who do not have substantial life-limiting comorbidities,” we offer TLE after a frank discussion regarding the risks and benefits of all potential management strategies for the Sprint Fidelis ICD lead, including continued monitoring, lead revision, and extraction with lead replacement. Although concerns regarding potential future lead failure certainly enter the equation, our rationale for this approach is primarily driven by the significant increasing need for countertraction sheath assistance with each additional month of implant duration (1), implying more difficulty and potentially more risk with TLE of the Sprint Fidelis ICD lead over time.
We remain steadfast in our assertion that decisions regarding extraction of the Sprint Fidelis ICD lead must be made on a case-by-case basis considering multiple patient- and physician-related variables because TLE has the potential for significant morbidity and mortality and may not be warranted in patients with a poor prognosis or where the risks of intervention clearly outweigh the benefits. Moreover, we reiterate that lead extractions should not be performed by those inexperienced in the procedure, by those without the necessary tools available to attain complete success, or in a setting not prepared and committed to the complete and safe performance of the procedure.
- American College of Cardiology Foundation