Multi-lead cephalic venous access and long-term performance of high-voltage leads

Area of Science:

• Cardiology
• Medical Devices
• Vascular Access

Background:

• Cardiac resynchronization therapy-defibrillator (CRT-D) implantation is a common procedure.
• The cephalic vein is a frequent access route for implantable cardioverter-defibrillator (ICD) leads.
• Previous studies suggested a potential link between cephalic vein access and increased ICD lead failure.

Purpose of the Study:

• To evaluate the association between CRT-D implantation via the cephalic vein and the incidence of ICD lead failure.
• To identify patient and lead characteristics associated with ICD lead failure in CRT-D patients.

Main Methods:

• Retrospective analysis of 633 patients from three centers (October 2008 - September 2017).
• Comparison of ICD lead failure rates between cephalic and non-cephalic access cohorts.
• Kaplan-Meier survival and Cox-regression analyses were used to determine predictors of lead failure.

Main Results:

• No statistically significant difference in ICD lead failure rates between cephalic (0.36%/year) and non-cephalic (0.13%/year) access groups.
• Female sex (55.6% vs. 17.9%) and hypertension (88.9% vs. 54.2%) were more prevalent in the lead failure cohort.
• Multivariate analysis identified female sex (HR, 7.12) and body mass index (BMI) (HR, 1.12) as significant predictors of ICD lead failure.

Conclusions:

• CRT-D implantation using the cephalic vein route is not associated with an increased risk of premature ICD lead failure.
• Female gender and elevated BMI are independent predictors of ICD lead failure in patients receiving CRT-D therapy.