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Lead age as a predictor for failure in pediatrics and congenital heart disease

Robert D Whitehill1,2, Stephanie F Chandler1, Elizabeth DeWitt1

  • 1Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Pacing and Clinical Electrophysiology : PACE
|January 12, 2021
PubMed

Insights

Transvenous lead failure is common in pediatric and congenital heart disease patients. Leads not yet replaced during generator changes showed higher failure rates, suggesting lead age may not be the sole predictor.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Pediatric Health

Background:

  • Pediatric and congenital heart disease (CHD) patients experience a high incidence of transvenous (TV) lead failure.
  • Understanding factors influencing TV lead longevity is crucial for patient management.

Purpose of the Study:

  • To investigate if transvenous lead age can predict lead failure in pediatric and congenital heart disease patients.
  • To inform decisions regarding lead replacement versus reuse during generator changes.

Main Methods:

  • A retrospective cohort study included patients under 21 years old who underwent TV device implantation between 2000 and 2014.
  • Data on patient, device, and lead variables were collected and analyzed.
  • Leads were grouped based on the number of completed generator changes.

Main Results:

  • Out of 393 leads in 257 patients, 15% (60 leads) failed.
  • Leads that had not undergone a generator change were more likely to fail (p=0.048).
  • Congenital heart disease, Tendril lead type, and silicone insulation were associated with failure. In multivariate analysis, younger leads, number of generator changes, CHD, and silicone insulation remained significant.

Conclusions:

  • Transvenous lead failure is a significant concern in pediatric and CHD populations.
  • Leads awaiting their first generator change demonstrated a higher failure risk.
  • Further research is needed to validate serial replacement strategies based on lead age in this patient group.
Abstract

Keywords:
adult congenital heart diseasepediatric cardiologytransvenous cardiac devices

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