Active-fixation leads had a 0.8% incidence of clinically relevant cardiac perforation; predictors included age >80 years (OR 3.84), female sex (OR 3.14), and apical RV lead position (OR 3.37).
Observational (n=2,200)
No
What is the incidence and what are the predictors of clinically relevant cardiac perforation associated with active-fixation pacing and defibrillation leads?
Active-fixation pacing and defibrillation leads have a low 0.8% incidence of clinically relevant cardiac perforation, though risk is significantly increased in females, patients over 80 years old, and with apical right ventricular lead positioning.
AIMS: Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating this complication are lacking. We sought to evaluate the incidence and predictors of clinically relevant cardiac perforation in a consecutive series of patients implanted with active-fixation pacing and defibrillation leads. METHODS AND RESULTS: We conducted a retrospective observational study including all consecutive patients implanted with an active-fixation pacing/defibrillation lead at our institution from July 2008 to July 2015. The incidence of clinically relevant cardiac perforation and cardiac tamponade was evaluated. Univariate and multivariate analyses were used to identify predictors of cardiac perforation. Acute and long-term management of these patients was also investigated. A total of 3822 active-fixation pacing (n = 3035) and defibrillation (n = 787) leads were implanted in 2200 patients. Seventeen patients (0.8%) had clinically relevant cardiac perforation (13 acute and 4 subacute perforations), and 13 (0.5%) had cardiac tamponade resolved with pericardiocentesis. None of the patients with cardiac perforation required surgical treatment. In multivariate analysis, an age >80 years (OR 3.84, 95% CI 1.14-12.87, P = 0.029), female sex (OR 3.14, 95% CI 1.07-9.22, P = 0.037), and an apical position of the right ventricular lead (OR 3.37, 95% CI 1.17-9.67, P = 0.024) were independent predictors of cardiac perforation. CONCLUSIONS: Implantation of active-fixation leads is associated with a low incidence of clinically relevant cardiac perforation. Older and female patients have a higher risk of perforation as well as those patients receiving the ventricular lead in an apical position.
Cano et al. (Wed,) conducted a observational in Active-fixation pacing and defibrillation lead implantation (n=2,200). Active-fixation pacing and defibrillation leads was evaluated on clinically relevant cardiac perforation. Active-fixation leads had a 0.8% incidence of clinically relevant cardiac perforation; predictors included age >80 years (OR 3.84), female sex (OR 3.14), and apical RV lead position (OR 3.37).