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Survival of transvenous ICD leads in young patients
William J Bonney1, Henry M Spotnitz, Leonardo Liberman
1Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York, NY, USA. toledowill@yahoo.com
Insights
Implantable cardioverter-defibrillator (ICD) lead survival in pediatric patients is high, with a 5-year survival rate of 89.6%. This study found lead failure rates in children comparable to those in adults when implanted by experienced operators.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Transvenous implantable cardioverter-defibrillator (ICD) leads have significant failure rates in adults, increasing over time.
- Limited data exists on lead survival specifically in pediatric populations.
- Assessing lead performance in young patients is crucial for long-term device management.
Purpose of the Study:
- To evaluate the lead survival rates in pediatric patients receiving transvenous ICDs.
- To identify potential predictors of lead failure in this demographic.
- To compare pediatric ICD lead survival with established adult data.
Main Methods:
- Retrospective review of 71 transvenous ICD leads implanted in patients under 21 years old between 1997 and 2007.
- Data collected included patient demographics, device specifics, implantation technique, and lead performance metrics.
- Lead failure was defined as any issue requiring surgical intervention; Kaplan-Meier analysis was used for survival assessment.
Main Results:
- Four lead failures occurred in 70 patients over a mean follow-up of 2.8 years.
- Three failures were due to lead fractures, and one involved detection issues.
- Kaplan-Meier analysis showed a 5-year lead survival rate of 89.6%, with no significant predictors identified.
Conclusions:
- Implantable cardioverter-defibrillator lead survival in pediatric patients is comparable to adult outcomes.
- Experienced operator involvement appears critical for achieving favorable lead survival in children.
- These findings support the use of transvenous ICDs in pediatric populations with appropriate expertise.
Background:
In adults, transvenous implantable cardioverter defibrillator (ICD) lead failure rates are significant, and their occurrence increases with time from implant. There are limited data in children. The goal of this study was to assess lead survival in young patients undergoing ICD implantation at a single center.
Methods:
Records of patients under 21 years old with transvenous ICD leads implanted at our center from June 1997 to August 2007 were retrospectively reviewed. Age, weight, height, diagnosis, lead and generator model, venous access technique, generator position, pacing thresholds, lead impedance, and R wave size were recorded. "Lead failure" was defined as any lead problem requiring surgical intervention to restore proper function to the ICD system.
Results:
Seventy-one transvenous leads were included (70 patients). Average age at implant was 14.8 years (range 5.7-19.5). All the devices were implanted by a single operator (HMS). Venous access was obtained via cephalic cutdown in 66/71. Mean follow-up time was 2.8 years (range 0.2-7.8 years, median 2.3 years). There were no infections requiring explantation. There were four lead failures. Three were lead fractures, occurring 12, 13, and 19 months after implant. The fourth lead failed when an arrhythmia was not appropriately detected, and a second dedicated rate-sensing lead was thus implanted. Univariate analysis did not identify any variable to be a significant predictor of lead failure. Kaplan-Meier survival analysis demonstrated 5-year lead survival at 89.6%.
Conclusions:
ICD lead survival in children, when performed by an experienced operator, is similar to that found in adults.
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