Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications
Chance M Witt1, Charles J Lenz1, Henry H Shih2
1Department of Cardiovascular Diseases.
Journal of Cardiovascular Electrophysiology
|May 26, 2017
Summary
Septal pacemaker leads reduce mortality but increase atrial fibrillation risk. Non-septal non-apical (NSNA) lead positions are linked to higher complications and should be avoided.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Right ventricular apex pacing has negative long-term effects.
- Nonapical pacing may offer improved outcomes.
- Data on nonapical lead position complications is limited.
Purpose of the Study:
- To assess long-term outcomes of cardiac pacing.
- To evaluate lead-related complications with different ventricular lead tip positions.
Main Methods:
- Retrospective analysis of 3,450 adult patients undergoing dual-chamber pacemaker implantation (2004-2014).
- Comparison of outcomes at 5 years between apical, septal, and nonseptal nonapical (NSNA) lead positions.
- Analysis included patients with >40% ventricular pacing.
Main Results:
- Septal leads showed lower mortality (24%) versus apical leads (31%, P=0.02).
- In patients with >40% pacing, septal leads had higher atrial fibrillation rates (49%) than apical leads (34%, P=0.04).
- NSNA positions had higher lead dislodgement (4% vs 2%, P=0.005) and revision rates (8% vs 5%, P=0.005).
Conclusions:
- Septal pacemaker lead placement is associated with reduced mortality but increased atrial fibrillation risk at higher ventricular pacing percentages.
- Non-septal nonapical (NSNA) lead positions are linked to increased complications and should be avoided.
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