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Generator replacement is associated with an increased rate of ICD lead alerts.

Abstract：

BACKGROUND:Lead malfunction is an important cause of morbidity and mortality in patients with an implantable cardioverter-defibrillator (ICD). We have shown that the failure of recalled high-voltage leads significantly increases after ICD generator replacement. However, generator replacement has not been recognized as a predictor of lead failure in general. OBJECTIVE:The purpose of this study is to assess the effect of ICD generator exchange on the rate of ICD lead alerts. METHODS:A time-dependent Cox proportional hazards model was used to analyze a database of remotely monitored ICDs. The model assessed the impact of generator exchange on the rate of lead alerts after ICD generator replacement. RESULTS:The analysis included 60,219 patients followed for 37 ± 19 months. The 5-year lead survival was 99.3% (95% confidence interval 99.2%-99.4%). Of 60,219 patients, 7458 patients (12.9%) underwent ICD generator exchange without lead replacement. After generator replacement, the rate of lead alerts was more than 5-fold higher than in controls with leads of the same age without generator replacement (hazard ratio 5.19; 95% confidence interval 3.45-7.84). A large number of lead alerted within 3 months of generator replacement. Lead alerts were more common in patients with single- vs dual-chamber ICDs and in younger patients. Sex was not associated with lead alerts. CONCLUSION:Routine generator replacement is associated with a 5-fold higher risk of lead alert compared to age-matched leads without generator replacement. This suggests the need for intense surveillance after generator replacement and the development of techniques to minimize the risk of lead damage during generator replacement.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Lovelock JD,Cruz C,Hoskins MH,Jones P,El-Chami MF,Lloyd MS,Leon A,DeLurgio DB,Langberg JJ

doi

10.1016/j.hrthm.2014.06.018

subject

Has Abstract

pub_date

2014-10-01 00:00:00

pages

1785-9

issue

10

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(14)00680-8

journal_volume

11

pub_type

杂志文章,多中心研究

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