Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2017; 5(2): 27-34
Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.27
Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?
Elia De Maria, Ambra Borghi, Lorenzo Bonetti, Pier Luigi Fontana, Stefano Cappelli
Elia De Maria, Ambra Borghi, Lorenzo Bonetti, Pier Luigi Fontana, Stefano Cappelli, Cardiology Unit, Ramazzini Hospital, 41012 Carpi (Modena), Italy
Author contributions: De Maria E contributed to conception and design of the work, drafting the article, final approval; Borghi A, Bonetti L, Fontana PL and Cappelli S contributed to drafting and critical revision of the work, final approval.
Conflict-of-interest statement: None to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Elia De Maria, MD, PhD, Chief of Arrhythmology Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012 Carpi (Modena), Italy.
Telephone: +39-05-9659320 Fax: +39-05-9659387
Received: August 19, 2016
Peer-review started: August 20, 2016
First decision: October 21, 2016
Revised: October 29, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: February 16, 2017
Processing time: 181 Days and 9.2 Hours
Core Tip

Core tip: Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator leads. Cables can externalize through the insulation (“inside-out” abrasion) and appear outside the lead body. Recently similar failure mechanisms have also been described for Biotronik leads. Some studies reported a high rate of electrical dysfunction (including insulation failure) with Biotronik Linox leads and a survival rate between 88% and 91% at 5 years, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries showed 96% survival rate at 5 years, well within industry standards.