Heart failure & cardiomyopathies
Left ventricular lead implantation failure in an unselected nationwide cohort
Authors' conclusion
LV lead implant failure is uncommon in the current era and is most commonly due to coronary sinus access failure. Predictors of LV lead implant failure included younger age, female sex, black race, Hispanic ethnicity, increased QRS duration, sleep apnea, and absence of electrophysiology training.
Study context
- Population
- Patients with LBBB and EF ≤ 35% undergoing planned de novo transvenous cardiac resynchronization therapy (CRT) implantation, 2010–2016
- Participants
- 111,802 patients
- Outcome
- LV lead implant failure (rates, reasons, independent predictors)
Methodological detailsnationwide registry (NCDR ICD Registry)
- Nationwide registry (NCDR ICD Registry)
Main finding
As reported in the abstract
LV lead implant failure
- Left ventricular (LV) lead implant failure
- 3.6% (n = 3979)
- Reason: venous access
- 7.5%
- Reason: coronary sinus access
- 64.3%
- Reason: tributary vein access
- 13.5%
- Reason: coronary sinus dissection
- 7.6%
- Reason: unacceptable threshold
- 4.4%
- Reason: diaphragmatic stimulation
- 1.7%
Observational data: associations, not effects.
Further findings
Independent predictors of LV lead implant failure (multivariable logistic regression)
| OR (95% CI) | ||
|---|---|---|
| Female sex | 1.38 (1.29–1.47) | |
| Hispanic ethnicity | 1.23 (1.08–1.40) | |
| OSA | 1.14 (1.04–1.24) | |
| 0.512Odds ratio (log scale) |
| Outcome | Estimate | |
|---|---|---|
| Independent predictors of LV lead implant failure (multivariable logistic regression)Black racevs White | OR 1.44 (95% CI 1.32–1.57) | |
| Independent predictors of LV lead implant failure (multivariable logistic regression)QRS duration | OR 1.055 per 10 ms (95% CI 1.038–1.072) | |
| Independent predictors of LV lead implant failure (multivariable logistic regression)Implanter without specialized trainingvs Electrophysiology trained | OR 1.53 (95% CI 1.34–1.76) | |
| 0.512Odds ratio (log scale) |
| Outcome | OR |
|---|---|
| Independent predictors of LV lead implant failure (multivariable logistic regression)Younger age · CI misprinted in abstract | 1.01 |
Original publication
Left ventricular lead implantation failure in an unselected nationwide cohort. Heart Rhythm. Published 3 July 2023. doi:10.
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