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Prediction of Midterm Performance of Active‐Fixation Leads Using Current of Injury
Author(s) -
HAGHJOO MAJID,
MOLLAZADEH REZA,
ASLANI AMIR,
DASTMALCHI JALAL,
MASHREGHIMOGHADAM HAMIDREZA,
HEIDARIMOKARAR HADI,
VAKILIZARCH ANOUSHIRAVAN,
ALIZADEH ABOLFATH
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12262
Subject(s) - medicine , fixation (population genetics) , current (fluid) , physical medicine and rehabilitation , environmental health , electrical engineering , engineering , population
Background There are only limited prospective data on the clinical relevance of current of injury (COI) as a predictor of the midterm performance of active‐fixation leads. This study sought to investigate whether it is possible to predict the midterm performance of active‐fixation leads using COI recorded at the time of implantation. Methods and results One hundred fifty patients (78 men; mean age, 63 ± 19 years) who received active‐fixation pacing (n = 201) and defibrillator (n = 51) leads were studied. COI was measured from the intracardiac bipolar electrogram recorded at the time of lead implantation. The study outcome was good lead performance at 6 months, defined as P wave ≥ 1.5 mV, threshold <1.5 V for atrial lead, R‐wave ≥ 5 mV, and threshold <1 V for ventricular lead. A total of 102 active‐fixation atrial and 150 ventricular leads were implanted. During a 6‐month follow‐up, invasive intervention was required for seven atrial and seven ventricular leads. In multivariate analysis, COI was the only independent predictor of good outcome for the active‐fixation atrial (odds ratio [OR]: 5.67, 95% confidence interval [CI]: 2.18–14.76, P = 0.001) and ventricular leads (OR: 3.99, 95% CI: 1.08–21.26, P = 0.002). Receiver‐operating characteristic analysis identified ST‐segment elevation ≥2.0 mV for the atrial leads (sensitivity, 75%; specificity, 89%) and ≥10.0 mV for the ventricular leads (sensitivity, 70%; specificity, 87%) as optimal cutoffs for good midterm performance. Conclusions Midterm performance of active‐fixation leads is predictable using COI recorded at the time of lead implantation. A ST‐segment elevation ≥2.0 mV in the atrial leads and ≥10.0 mV in the ventricular leads are recommended to improve the lead performance at 6 months.