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Published on: February 28, 2012
Predictors of Early Cardiac Implantable Electronic Device Lead Dislodgement in the Elderly
Rafal Mlynarski1,2, Agnieszka Mlynarska2,3, Michal Joniec2,4
1Department of Electroradiology, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland.
Insights
Frailty is a significant predictor of early lead dislodgement in elderly patients receiving cardiac implantable electronic devices (CIEDs). Assessing frailty can help prevent complications in this vulnerable population.
Area of Science:
- Cardiology
- Geriatrics
- Medical Devices
Background:
- Lead dislodgement is a common complication of cardiac implantable electronic device (CIED) implantation, particularly in older adults.
- Limited evidence exists regarding the impact of frailty on CIED lead dislodgement risk.
- Frailty assessment may be crucial for procedural safety and patient outcomes in elderly individuals with cardiovascular conditions.
Purpose of the Study:
- To investigate the risks and predictors of early lead dislodgement following CIED implantation in the elderly population.
- To determine if frailty is an independent predictor of lead dislodgement in this demographic.
Main Methods:
- Retrospective analysis of 14,293 CIED implantations between 2008 and 2021.
- Focus on 400 elderly patients with confirmed lead dislodgement.
- Retrospective calculation of frailty scores.
Main Results:
- Atrial lead dislodgement was the most frequent type (33.3%).
- Frailty (OR: 1.82) and increasing age (OR: 1.03) were independent predictors of early lead dislodgement.
- Frailty independently predicted early dislodgement in both female (OR: 2.12) and male (OR: 1.63) subgroups.
Conclusions:
- Lead dislodgement is prevalent in the elderly population.
- Frailty serves as a significant predictive factor for early lead dislodgement in both genders.
- Incorporating frailty evaluation into patient selection for CIED procedures may enhance safety and reduce complications in the elderly.
Introduction:
One of the most frequent cardiac implantable electronic device (CIED) implantation complications is lead dislodgement, especially in the older adult population. Little evidence is available about the influence of frailty on the risk of lead dislodgment after CIED implantation procedures; thus, the evaluation of frailty could be relevant for the course and safety of the implantation procedure, especially among the elderly with cardiovascular diseases. This study aimed to assess the risks and predictors of early lead dislodgement in the elderly population.
Methods:
Between 2008 and 2021, 14,293 patients underwent implantations. In 400 elderly patients, lead dislodgement was confirmed, and frailty was retrospectively calculated.
Results:
The most frequent dislodgement according to the lead position was that of the atrial lead (133; 33.3%). In the logistic regression, frailty (OR: 1.8196, 95% CI:1.4991-2.2086; p < 0.0001) and age (OR: 1.0315, 95% CI:1.0005-1.0634; p < 0.0461) were independent predictors of early dislodgement. In the female group, frailty (OR: 2.1185, 95% CI: 1.5530-2.8899; p < 0.0001) was an independent predictor of early dislodgement. Similarly, in the male group, frailty (OR: 1.6321, 95% CI:1.2725-2.0934; p < 0.0001) was an independent predictor of early dislodgement.
Conclusion:
Lead dislodgement often occurs in the elderly. Frailty in both men and women is a predictive factor of early lead dislodgment. Evaluating frailty may be an essential element of proper selection, especially in the elderly undergoing CIED procedures, and, consequently, it could help prevent further complications.
