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Published on: July 18, 2014
Riata lead failure in pediatric and congenital heart disease patients
Carolina A Escudero1, Douglas Y Mah2, Christina Y Miyake3
1Department of Pediatrics, Division of Cardiology, University of Alberta and Stollery Children's Hospital, Edmonton, Canada.
Insights
Implantable cardioverter defibrillator lead failures are common in pediatric and congenital heart disease patients. The Riata lead showed a high rate of electrical failure, suggesting a need for proactive management strategies.
Area of Science:
- Cardiology
- Biomedical Engineering
- Pediatric Electrophysiology
Background:
- Implantable cardioverter defibrillator (ICD) lead failures are a significant concern, particularly in pediatric and congenital heart disease (CHD) populations.
- Previous studies indicate a higher incidence of lead complications in these vulnerable patient groups.
Purpose of the Study:
- To investigate the rate and timing of Riata and Riata ST lead failures in pediatric and adult patients with CHD.
- To assess the prevalence and temporal characteristics of electrical failure and conductor coil externalization (CCE).
Main Methods:
- A retrospective, multicenter cohort study was conducted involving pediatric and adult CHD patients who received Riata or Riata ST leads between 2002 and 2009.
- Data on electrical failure and CCE were collected and analyzed to determine lead survival rates.
Main Results:
- The study included 58 patients and 63 leads, with a median follow-up of 8.7 years.
- Electrical failure occurred in 43% of leads, and conductor coil externalization (CCE) in 16%, with median lead ages of 4.7 and 4.3 years, respectively.
- Median lead survival free from electrical failure or CCE was 7.9 years; 41% of leads remained functional at follow-up.
Conclusions:
- Riata leads exhibit a high rate of electrical failure in pediatric and CHD patients.
- The rate of conductor coil externalization (CCE) was consistent with existing data.
- Clinical management strategies should consider the elevated risk of electrical failure, potentially necessitating elective lead replacement.
Background:
Implantable cardioverter defibrillator (ICD) lead failures occur at higher rates in pediatric and congenital heart disease (CHD) patients.
Objective:
To determine the rate and timing of Riata lead failure in pediatric and CHD patients.
Methods:
This was a retrospective, multicenter cohort study of pediatric patients and adults with CHD with implantation of a Riata or Riata ST lead between 2002 and 2009. The prevalence and timing of electrical failure and conductor coil externalization (CCE) were determined.
Results:
Fifty-eight patients and 63 leads from seven centers were included. Median (interquartile range [IQR]) age at implant was 14.4 (11.5-18.7) years and median follow-up was 8.7 (7.3-11.1) years. The underlying diagnosis was a primary arrhythmia disorder in 45%, cardiomyopathy in 31%, and CHD in 28% of patients. Electrical failure occurred in 43% and CCE in 16% of leads at median lead ages of 4.7 (3.4-7.5) and 4.3 (3.9-7.0) years, respectively. Median lead survival free from electrical failure or CCE was 7.9 (95% confidence interval, 5.8-10.0) years. Forty-one percent of leads were functional at the end of the follow-up period, and 33% were extracted with a complication rate of 5%.
Conclusions:
The rate of Riata lead electrical failure was high in children and patients with CHD, while the rate of CCE was comparable with published data. Counseling on lead management should factor in the high rate of electrical failure with considerations for elective replacement.
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