OBJECTIVETo analyze major probable causes, locations and remedies of lead fractures in implanted pacemaker and implanted cardioverter defibrillator (ICD) .

METHODSFrom January 1982 to November 2004, on all the pacemakers and ICDs implanted at this hospital, lead fractures were detected timely by regular telemetric programmed testing, chest radiography and electrocardiography. Appropriate remedial actions were given and follow up visits were done to verify the results.

RESULTSOf all the 4698 pacemakers and 161 ICDs, there were 29 lead fractures on 31 leads with an incidence rate of 0.6%. The incidence rate of lead fracture was 0.9% for pacemakers/defibrillators implanted by subclavian venipuncture, while it was 0.4% for pacemakers/defibrillators implanted by cephalic venotomy (P = 0.04). Fracture locations: 22 cases at the sub clavicle, 6 cases in the pacemaker pocket, and 1 case in the right ventricle. Among the 29 cases, 24 were implanted with additional new leads, 3 cases whose atrial leads were fractured were switched from DDD mode to VVI. All the patients were followed up for an average of 5.6 months +/- 16.1 months. In one patient, the lead was removed through thoracotomy due to infection of exposed lead.

CONCLUSIONSCephalic venotomy is the first choice for pacemaker and ICD implantation, and the second choice is subclavian venipuncture in the outer part of subclavian vein, which has a higher incidence rate of lead fracture. Most lead fractures are detected at the region of medial subclavian. Regular follow-up can help timely detect fractures, so that the cases can be dealt with properly.