Long-Term Implantable Cardioverter Defibrillator Lead Dysfunction After Left Ventricular Assist Device Implantation

Figures

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  Figure 1. Recruitment Strategy of Our Study ICD = implantable cardioverter defibrillator; LVAD = left ventricular assist device.

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  Figure 2. Timing of Lead Dysfunction (A) Shows the frequency of lead dysfunction among all 170 included leads. (B) Shows the timing of lead dysfunction in persistent (N = 84) and temporary (N = 40) leads. Abbreviations as in Figure 1.

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  Figure 3. Area Under the Receiver Operating Characteristic Curve for Lead Dysfunction ROC analysis showed lead dysfunction occurring more than 2.1 months after LVAD implantation was predictive of persistent (N = 84) compared to temporary (N = 40) lead dysfunction (AUC, 0.673; P = 0.044; sensitivity, 0.785; specificity, 0.600). The 95% confidence intervals for AUC, sensitivity, and specificity were 0.57 to 0.78, 0.71 to 0.86, and 0.60 to 0.90, respectively. ROC=receiver operating characteristics; other abbreviations as in Figure 1.

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  Figure 4. Changes of Each Lead Parameter (A) Sensing. (B) Pacing threshold. (C) Right ventricular impedance. (D) High-voltage impedance. Comparison of the individual lead parameters before (pre) LVAD implantation, one (1y) and 2 years (2y) after LVAD implantation during the follow-up period. The Kruskal-Wallis test was used to compare the medians among 3 groups. When the Kruskal-Wallis test indicated significant differences, post hoc pairwise comparisons were conducted using Dunn’s multiple comparison test with Bonferroni correction to identify which groups differed. When the Kruskal-Wallis test indicated no significant differences, only P values from the Kruskal-Wallis test were reported. Statistical significance is indicated as follows: ∗P < 0.05, ∗∗P < 0.01. HV = high-voltage; RV = right ventricular.

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  Figure 5. Survival After Left Ventricular Assist Device Implantation (A) Kaplan-Meier curve of all included patients (N = 170). (B) Comparison of time to death after LVAD implantation between patients in persistent and no persistent lead dysfunction group (N = 84 vs 86). There was no significant difference between these groups according to the log-rank test (P = 0.22). Abbreviations as in Figure 1.

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  Central Illustration. Implantable Cardioverter Defibrillator Lead Dysfunction After Left Ventricular Assist Device Implantation BTT = bridge to transplantation; ICD = implantable cardioverter defibrillator; LVAD = left ventricular assist device; ROC = receiver operating characteristics.