Author reply

Le résumé fourni par la source

With regards to the letter from Dr Ishimura et al.,1 which refers to our article,2 we appreciate the opportunity to respond to their comments. The observation by the Ishimura group regarding the Petite 58ERB pacemaker lead has similarities with our findings on the Sorin Hepta 4B pacemaker lead. Both leads show an unexpected high failure rate, with an increase in impedance suggesting lead fracture in most cases. However, the exact underlying mechanism of the failure has yet to be found. We immediately informed Sorin about our findings but no suitable explanation came to light. As stated by Dr Ishimura, breaching of the outer insulation preceding conductor fracture can remain unrevealed, as the conductors are individually insulated. Of note, the Petite 58ERB lead and the Sorin Hepta 4B lead have a different outer insulation. As mentioned by Dr Ishimura, one of the possible advantages of the thinner co-radial lead design is the reduction of subclavian crush. We would rather advocate access through the cephalic or axillary vein as a measure to avoid subclavian crush instead of choosing for thinner leads. We fully support the Ishimura statement on the quest for thinner leads; ‘thinner may not always be better’. It is noteworthy, and yet worrisome, that other centres now report high failure rate of a lead from a different manufacturer, but of a comparable design. Cautious follow-up of the performance of all co-radial pacemaker leads is mandatory. In general, it is essential that any unfavourable lead function is immediately reported to the manufacturer. The results from large cohort studies, like the FOLLOWPACE study and the Danish Pacemaker Register, show discrepancies with lead performance reported by the manufacturers.3–5 This emphasizes the importance of reporting all lead and device-related malfunctions to the manufacturers. Physicians and manufacturers have to join hands to retrieve the cause of lead failures. Possible lead problems that are unidentified will remain unsolved. Conflict of interest: none declared.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.