Pacing and clinical electrophysiology : PACE · 2018
Analysis of electrical lead failures in patients referred for transvenous lead extraction procedures.
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Ząbek Andrzej, Boczar Krzysztof, Dębski Maciej, Ulman Mateusz, Matusik Paweł T, Lelakowski Jacek, Małecka Barbara
Аннотация
INTRODUCTION: We evaluated the influences of selected factors on electrical lead failure (ELF) occurrence in patients referred for transvenous lead extraction (TLE) procedures.
METHODS AND RESULTS: The study cohort consisted of 432 patients referred for TLE procedures due to various indications (42 - lead-dependent infective endocarditis, 47 - pocket infection, 343 - noninfectious indications) with a total of 804 endocardial leads. In the analyzed group, there were 192 patients with ELF, denoted as group ELF(+) (200 malfunctioning endocardial leads). The percentage of women was higher in the ELF(+) group than in the ELF(-) group (42.7% vs 30.0%; P = 0.006). The ELF(+) patients had more endocardial leads implanted via subclavian vein puncture (80.0% vs 72.4%; P = 0.032), had more indwelling leads in the cardiovascular system (1.94 vs 1.8; P = 0.03), were older (68.9 vs 66.0 years old; P = 0.028), and had better left ventricular ejection fractions than the ELF(-) patients (48.0% vs 40.7%; P < 0.001). The time interval to ELF occurrence was significantly longer for pacing leads than for cardioverter-defibrillator leads (95.7 vs 65.7 months; P = 0.016). The most important factor associated with ELF was subclavian vein puncture, increasing the risk of ELF occurrence by 2.5-fold and 2.7-fold in the univariate and multivariate Cox proportional hazards regression models, respectively. The presence of a cardioverter-defibrillator lead increased the risk of ELF by 1.9-fold and 2.7-fold in the univariate and multivariate models, respectively.
CONCLUSION: The most significant factors predisposing patients to ELF are the lead implantation approach and the presence of a cardioverter-defibrillator lead.
METHODS AND RESULTS: The study cohort consisted of 432 patients referred for TLE procedures due to various indications (42 - lead-dependent infective endocarditis, 47 - pocket infection, 343 - noninfectious indications) with a total of 804 endocardial leads. In the analyzed group, there were 192 patients with ELF, denoted as group ELF(+) (200 malfunctioning endocardial leads). The percentage of women was higher in the ELF(+) group than in the ELF(-) group (42.7% vs 30.0%; P = 0.006). The ELF(+) patients had more endocardial leads implanted via subclavian vein puncture (80.0% vs 72.4%; P = 0.032), had more indwelling leads in the cardiovascular system (1.94 vs 1.8; P = 0.03), were older (68.9 vs 66.0 years old; P = 0.028), and had better left ventricular ejection fractions than the ELF(-) patients (48.0% vs 40.7%; P < 0.001). The time interval to ELF occurrence was significantly longer for pacing leads than for cardioverter-defibrillator leads (95.7 vs 65.7 months; P = 0.016). The most important factor associated with ELF was subclavian vein puncture, increasing the risk of ELF occurrence by 2.5-fold and 2.7-fold in the univariate and multivariate Cox proportional hazards regression models, respectively. The presence of a cardioverter-defibrillator lead increased the risk of ELF by 1.9-fold and 2.7-fold in the univariate and multivariate models, respectively.
CONCLUSION: The most significant factors predisposing patients to ELF are the lead implantation approach and the presence of a cardioverter-defibrillator lead.