Heart failure & cardiomyopathies
Lead replacement due to non-infectious reasons in patients with cardiac resynchronization therapy in long-term follow-up
- consecutive patients who received conventional cardiac resynchronization therapy (CRT) implants at a university hospital
- single university hospital
- 2002–2019
+2 more
- single university hospital
- 2002–2019
Authors' conclusion
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.
Study context
- Population
- Patients who received conventional CRT implants at a university hospital between 2002 and 2019
- Participants
- 1,059 consecutive patients
- Comparison
- lead-related re-do procedures vs no need for re-intervention
- lead-related re-do proceduresn = 251
Main finding
As reported in the abstract
leads replaced
324
patients with lead replacement
251 patients (23.7%)
overall crude incidence of lead replacement
19.4 events per 1000 lead-years
of those who required lead replacement, underwent the procedure within the first year after CRT implantation
126 subjects (50.2%)
Further findings
Independent predictors of lead replacement (multivariable analysis)
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Duration of the index CRT procedure · multivariable analysis | 1.03 (1.01–1.06) | P = 0.02 | |
| 0.512Hazard ratio (log scale) |
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Independent predictors of lead replacement (multivariable analysis) — fluoroscopy time · per-unit; unit not printed · multivariable analysis | 1.11 (1.02–1.15) | P = 0.01 | |
| 0.512Hazard ratio (log scale) |
Overall long-term mortality
- Overall long-term mortality — not associated
- P = .3
Lead replacement among patients followed for more than 10 years
- patients followed for more than 10 years
- n = 143; 13.5%
- of those followed >10 years, one or more lead replacements
- 67 subjects (46.8%)
Replaced leads by type
- left ventricular
- 11.2%; 21.4 replacements per 1000 lead-years
- right ventricular
- 10.8%; 20.5 replacements per 1000 lead-years
- right atrial
- 4%; 7.6 replacements per 1000 lead-years
- approximate rates
Safety
Device-related infective endocarditis
- Device-related infective endocarditis — not associated
- P = .82
Original publication
Summarised from the published abstract; every number is checked against it