ESC heart failure · 2026
Lead replacement due to non-infectious reasons in patients with cardiac resynchronization therapy in long-term follow-up.
СтатьяНазвание и аннотация: Перевод в очереди
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Jędrzejczyk-Patej Ewa, Mazurek Michał, Sokal Adam, Kotalczyk Agnieszka, Gumprecht Jakub, Kowalczyk Jacek, Pruszkowska Patrycja, Kowalski Oskar, Lenarczyk Radosław, Kalarus Zbigniew
Аннотация
BACKGROUND: Traditional cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure.
OBJECTIVE: The study aimed to determine the long-term durability of CRT leads, factors predisposing to lead replacement, and the outcomes of lead replacement in CRT patients.
METHODS: The study population comprised 1059 consecutive patients who received conventional CRT implants at a university hospital between 2002 and 2019.
RESULTS: During a median follow-up of 1661 days (interquartile range: 815-2792), a total of 324 leads were replaced in 251 patients (23.7%) for non-infectious reasons. The overall crude incidence of lead replacement was 19.4 events per 1000 lead-years. Of those who required lead replacement, 126 subjects (50.2%) underwent the procedure within the first year after CRT implantation. Among patients followed for more than 10 years (n = 143; 13.5%), 67 subjects (46.8%) had one or more lead replacements. Duration of the index CRT procedure and fluoroscopy time were independent predictors of lead replacement in a multivariable analysis [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.06, P = .02 and HR 1.11, 95% CI 1.02-1.15, P = .01, respectively]. The leads that required replacement were left ventricular (11.2%), right ventricular (10.8%), and right atrial (4%), corresponding to approximate rates of 21.4, 20.5, and 7.6 replacements per 1000 lead-years, respectively. Compared with no need for re-intervention, lead-related re-do procedures were not associated with overall long-term mortality (55.3% vs 51%, P = .3) or the incidence of device-related infective endocarditis (5.6% vs 4.5%, P = .82).
CONCLUSIONS: Almost 25% of patients with CRT require lead replacement during long-term follow-up for non-infectious reasons, and half of those require replacement within the first year. Over 10 years, nearly every second patient requires a lead-related redo procedure. Lead replacement was not associated with long-term all-cause mortality. Systematic proficiency-based training should be introduced as a routine strategy in the education of novice implanters.
OBJECTIVE: The study aimed to determine the long-term durability of CRT leads, factors predisposing to lead replacement, and the outcomes of lead replacement in CRT patients.
METHODS: The study population comprised 1059 consecutive patients who received conventional CRT implants at a university hospital between 2002 and 2019.
RESULTS: During a median follow-up of 1661 days (interquartile range: 815-2792), a total of 324 leads were replaced in 251 patients (23.7%) for non-infectious reasons. The overall crude incidence of lead replacement was 19.4 events per 1000 lead-years. Of those who required lead replacement, 126 subjects (50.2%) underwent the procedure within the first year after CRT implantation. Among patients followed for more than 10 years (n = 143; 13.5%), 67 subjects (46.8%) had one or more lead replacements. Duration of the index CRT procedure and fluoroscopy time were independent predictors of lead replacement in a multivariable analysis [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.06, P = .02 and HR 1.11, 95% CI 1.02-1.15, P = .01, respectively]. The leads that required replacement were left ventricular (11.2%), right ventricular (10.8%), and right atrial (4%), corresponding to approximate rates of 21.4, 20.5, and 7.6 replacements per 1000 lead-years, respectively. Compared with no need for re-intervention, lead-related re-do procedures were not associated with overall long-term mortality (55.3% vs 51%, P = .3) or the incidence of device-related infective endocarditis (5.6% vs 4.5%, P = .82).
CONCLUSIONS: Almost 25% of patients with CRT require lead replacement during long-term follow-up for non-infectious reasons, and half of those require replacement within the first year. Over 10 years, nearly every second patient requires a lead-related redo procedure. Lead replacement was not associated with long-term all-cause mortality. Systematic proficiency-based training should be introduced as a routine strategy in the education of novice implanters.