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Lead age as a predictor for failure in pediatrics and congenital heart disease
Author(s) -
Whitehill Robert D.,
Chandler Stephanie F.,
DeWitt Elizabeth,
Abrams Dominic J.,
Walsh Edward P.,
Kelleman Michael,
Mah Douglas Y.
Publication year - 2021
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.14166
Subject(s) - medicine , cohort , lead (geology) , pediatrics , retrospective cohort study , disease , surgery , geology , geomorphology
Background Pediatric and congenital heart disease (CHD) patients have a high rate of transvenous (TV) lead failure. Objective To determine whether TV lead age can aid risk assessment for lead failure to guide the decision of whether a lead should be replaced or reused at the time of a generator change. Methods Retrospective cohort study of patients <21 years old undergoing TV device implant from 2000 to 2014 at our institution. Patient, device, and lead variables were collected. Leads were compared in groups based on how many generator changes were completed. Results A total of 393 leads in 257 patients met inclusion criteria, 60 leads failed (15%). Failed leads were more likely to have not yet undergone generator change ( p = .048). CHD ( p = .045), Tendril lead type ( p = .02) and silicone insulation ( p = .02) were associated with failure. In multivariate analysis, younger leads ( p = .022), number of generator changes ( p = .003), CHD ( p = .005) and silicone insulation ( p = .004) remained significant while Tendril lead type did not ( p = .052). Survival curves show an early decline around 4 years. Conclusions Lead failure rate in pediatric and CHD patients is high. Leads that have not yet undergone a generator change were more likely to fail in this cohort. The strategy of serial replacement based on lead age needs further research to justify in this population.