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Comparative Chronic Valve and Venous Effects of Lumenless versus Stylet‐Delivered Pacing Leads in Patients with and Without Congenital Heart
Author(s) -
BHARMANEE APINYA,
ZELIN KATHLEEN,
SANIL YAMUNA,
GUPTA POOJA,
KARPAWICH PETER P.
Publication year - 2015
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.12728
Subject(s) - medicine , stylet , cardiology , venous valves , transvenous pacing , cardiac pacing , ventricular pacing , surgery , heart failure , vein
Background Standard, 5–7‐Fr diameter pacing leads (PLs) can adversely affect atrioventricular valve (AVV) and venous (superior vena cava [SVC], innominate [INN]) integrities. Although chronic pacing/sensing performances have been reported on the steroid‐eluting, lumenless, 4.1‐Fr PL (Model 3830, Medtronic Inc., Minneapolis, MN, USA), comparative valve and venous effects are largely unknown. Methods Patients (n = 134) were divided into two PL groups: Group 1 (n = 65, Model 3830) and Group 2 (n = 69, various 5–7 Fr models) and followed up to 9 years postimplant. Patient demographics, clinical findings, valve function, and venous dimensions were reviewed. Statistical significance was defined as P < 0.05. Results Patient implant age (mean 16.4 years vs 17.3 years), presence of congenital heart defect (CHD), and preexisting valve issues were comparable between groups. New or worsening valve insufficiency occurred in 12% of Group 1 patients (mean follow‐up 4.3 ± 2.8 years) and 27% of Group 2 patients (mean follow‐up 6.2 ± 3.5 years; P < 0.05). Significant SVC or INN narrowing was found in 11 % of Group 1 and 24% of Group 2 patients (P = 0.0004). All Group 1 patients <12 years of age showed normal while 50% of those from Group 2 exhibited stunted SVC or INN growth (P < 0.05). Conclusion The lumenless, 4.1‐Fr diameter PL offers improved clinical benefits, better AVV integrity, and venous development compared with larger 5–7‐Fr diameter PL and should be considered especially in younger patients with/without CHD.