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Patient- and lead-related factors affecting lead fracture in children with transvenous permanent pacemaker
Hasim Olgun1, Tevfik Karagoz, Alpay Celiker
1Division of Pediatric Cardiology, Department of Pediatrics, Ataturk University, Erzurum, Turkey.
Insights
In children with transvenous pacemakers, lead fracture is not linked to patient factors. Passive fixation mechanisms appear safer, reducing the risk of pacemaker lead fractures.
Area of Science:
- Pediatric cardiology
- Biomedical engineering
- Medical device research
Background:
- Transvenous pacing lead fracture is a common cause of lead abandonment.
- Previous studies explored lead failure factors, but none focused on pediatric clinical parameters affecting lead fracture.
Purpose of the Study:
- To investigate clinical parameters associated with transvenous pacing lead fracture in pediatric patients.
- To identify risk factors for lead fracture in children requiring pacemakers.
Main Methods:
- Retrospective analysis of 264 leads from 184 pediatric patients with transvenous pacemakers.
- Evaluation of patient conditions, implant data, and lead features for lead fracture analysis.
- Multivariate analysis to identify correlations between lead fracture and risk factors.
Main Results:
- Lead fracture occurred in 7.2% of leads (19/264) over a mean follow-up of 72.8 months.
- All fractures were in leads implanted via the infraclavicular subclavian approach, though not statistically significant.
- Lead fracture correlated significantly only with the fixation mechanism (P < 0.05).
Conclusions:
- Patient-related factors did not correlate with lead fracture in pediatric patients.
- Passive fixation mechanisms demonstrated a safer profile regarding lead fracture compared to active fixation.
- Further investigation into the impact of the extrathoracic approach on lead fracture is warranted.
Aims:
Fracture in transvenous pacing leads is one of the most common reasons for lead abandonment. Although the factors affecting lead failure rates have been investigated, there is no study evaluating the clinical parameters that affect lead fracture in children. We report our experience with lead fracture in children with transvenous pacemakers.
Methods And Results:
The follow-up results of 264 leads from 184 patients were evaluated using pacemaker follow-up data. Underlying conditions, implant data, and lead features were evaluated for the analysis of lead fracture. During a mean follow-up of 72.8 +/- 39.7 months (range 3.2-160.6, median 70), lead fracture developed in 19 leads (7.2%) from 18 patients. The mean duration between implantation and lead fracture was 57.3 +/- 35 months (range 6.8-130, median 51). All fractures occurred in the leads implanted by the infraclavicular subclavian approach. Cumulative survival at the end of 5 years was 92.7% in terms of lead fracture. None of the patient-related risk factors correlated with lead fracture. Multivariate analyses of lead-related risk factors revealed a significant correlation only between lead fracture and fixation mechanism (P < 0.05).
Conclusion:
Our results indicated that none of the patient-related risk factors was correlated with lead fracture. Among lead-related risk factors, only the fixation mechanism was found to be correlated with lead fracture; thus, it seems that passive fixation mechanism is safer in terms of lead fracture. Although all fractures occurred in the leads implanted by the intrathoracic subclavian approach, statistical analysis revealed no significance for this parameter. The effect of the extrathoracic approach should be investigated in a large group of patients.
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