Non-infective left ventricular lead complications requiring re-intervention following cardiac resynchronization therapy: prevalence, causes and outcomes

Christoffer Tobias Witt, Marie Jennyfer Ng Kam Chuen, Mads Brix Kronborg, Jens Kristensen, Christian Gerdes, Jens Cosedis Nielsen

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Abstract

PURPOSE: Left ventricular (LV) lead complications in cardiac resynchronization therapy are challenging and poorly reported. We aimed to establish prevalence, causes and outcomes of LV lead complications requiring re-intervention.

METHODS: We analysed the rate of complications in 2551 consecutive patients who received a transvenous de novo LV lead as part of a cardiac resynchronization therapy device between 2000 and 2018. LV lead complications requiring re-intervention were identified; those due to infection were excluded. Patient, procedural and device characteristics, and outcomes were examined for non-infective LV lead complications requiring re-intervention.

RESULTS: During a median of 4.7 years, 142 (5.6%) patients required re-intervention for non-infective LV lead complications with a decrease from 10.7% between 2000 and 2004, 8.7% between 2005 and 2009, 3.2% between 2010 and 2014 to 3.2% after 2014. The most common complications were LV lead displacement (50%), high pacing threshold (28%) and phrenic nerve stimulation (15%). Of the complications, 79 (56%) occurred within 90 days post-implant and 63 (44%) later. At the end of the study period, 132/142 patients (93%) had a functional LV lead. Lead re-intervention was associated with higher risk of complications (20%), but no increase in mortality (P = 0.19). Quadripolar leads had longer longevity and lower risk of complications compared with unipolar and bipolar LV leads.

CONCLUSIONS: A small but significant proportion of patients required LV lead re-intervention for complications following de novo implant. Lead displacement accounted for half of the re-interventions. Re-intervention was associated with a higher complication rate, but 92% of these patients had functional LV leads at the end of follow-up.

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
Volume63
Issue1
Pages (from-to)69-75
Number of pages7
ISSN1383-875X
DOIs
Publication statusPublished - Jan 2022

Keywords

  • Cardiac resynchronization therapy complications
  • LV lead complications
  • LV lead outcomes
  • LV lead re-intervention
  • Prevalence
  • Humans
  • Treatment Outcome
  • Heart Failure/therapy
  • Cardiac Resynchronization Therapy Devices
  • Cardiac Resynchronization Therapy

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