Key result
Younger transvenous leads and those without a prior generator change were significantly associated with lead failure in pediatric and congenital heart disease patients (p=0.022).
Why the study?
Pediatric and CHD patients have high transvenous lead failure rates, and whether lead age can aid risk assessment to guide lead replacement or reuse during generator changes is unclear.
Does transvenous lead age predict lead failure in pediatric and congenital heart disease patients?
Cohort (n=257)
No
Does transvenous lead age predict lead failure in pediatric and congenital heart disease patients?
p-value: p=0.022
These associations in retrospective data should not yet change lead management; hypothesis-generating for prospective validation in congenital heart disease.
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.
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Whitehill et al. (2021) conducted a cohort in Pediatric and congenital heart disease (n=257). Younger lead age and no prior generator change vs. Older leads and prior generator changes was evaluated on Lead failure (p=0.022). Younger transvenous leads and those without a prior generator change were significantly associated with lead failure in pediatric and congenital heart disease patients (p=0.022).
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