This morning in Boston, HRS 2012 sessions began with a state-of-the-art session on St. Jude ICD leads.\u00a0 Riata, Riata ST, and Durata are being discussed at the first large electrophysiology meeting since this lead came under FDA recall.<\/p>\n
It was obvious at the outset that this is a vital topic to the EP community.\u00a0 Those who didn\u2019t arrive early were relegated to a remote viewing station.\u00a0 Even there, the crowd was very large and engaged.<\/p>\n
Kenneth Ellenbogen started the presentation with updated data on the VA Riata and Riata ST leads.\u00a0 Interestingly, these data actually showed an increased failure rate of Riata ST as compared to Riata.\u00a0 This stands in distinction to data from the Minneapolis Multicenter Data presented later in the late breaking trials session.<\/p>\n
Things got interesting with the discussions of the clinical aspects of Riata lead management.\u00a0 Dr. Larry Epstein of Boston highlighted potential management strategies.\u00a0 He advised against placement of a sensing lead alone if the lead has failed.\u00a0 In explaining why \u201cI\u2019m scared about Riata,\u201d he gave the account of a patient with completely normal lead parameters that fortuitously suffered a cardiac arrest in his hospital.\u00a0 The ICD was ineffective at terminating the arrhythmia and the patient had to be externally defibrillated.\u00a0 To screen for these sort of silent lead failures, he performs fluoroscopy and high-energy shock delivery on his Riata leads before scheduled generator changes.<\/p>\n
Dr. Roger Carillo of Miami outlined his approach to Riata lead management as well.\u00a0 He expressed concern over the potential for thrombus formation on externalized leads.\u00a0 He advocated routine fluoroscopic exams on all Riata leads.\u00a0 He then performs transeosphageal echo on externalized leads and anticoagulates those with thrombus.\u00a0 He presented a step-by-step account of the unique challenges of Riata lead extraction.\u00a0 Warning of a variety of pitfalls and complications, he added, \u201cif you fail to follow any of these steps, the lead will not forgive you.\u201d<\/p>\n
The session ended with more calming words from Charles Love of Columbus.\u00a0 In his talk on Durata leads, he repeatedly emphasized \u201cit is a very, very different lead.\u201d\u00a0 He spent some time going over the design of all St. Jude leads and pointed out the potential benefit of the Optim insulation coating added to Durata and Riata ST Optim leads.\u00a0 Active registries on these newer leads continue to show robust performance approaching 5 years.\u00a0 He did acknowledge the small numbers of leads in late follow up. \u00a0But in the question and answer section, not all were convinced.\u00a0 Dr. Larry Epstein stated, \u201cI still have issues with trust.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
The Heart Rhythm Society meeting kicked off in Boston this morning. Edward Schloss recounts the important opening session in which FDA-recalled St. Jude ICD leads Riata, Riata ST, and Durata were discussed.<\/p>\n","protected":false},"author":556,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[1265,681,975,1264,1209],"class_list":["post-28933","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","tag-durata","tag-icd-leads","tag-riata","tag-riata-st","tag-st-jude-medical"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28933","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/556"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=28933"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28933\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=28933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=28933"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=28933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}