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Predictors of the right ventricular perforation caused by active-fixation pacing and defibrillator leads: A
Umut Celikyurt1, Burak Acar1, Sadan Yavuz2
1Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, Kocaeli, Turkey.
Insights
Active-fixation leads can cause cardiac perforation. Radiographic predictors like lead slack and width during implantation can help identify patients at risk for right ventricular perforation.
Area of Science:
- Cardiology
- Medical Devices
- Radiology
Background:
- Active-fixation leads are linked to increased cardiac perforation rates.
- Limited research exists on radiographic predictors of right ventricular (RV) lead perforation.
Purpose of the Study:
- To identify radiographic predictors of RV lead perforation.
- To evaluate the association between lead characteristics and perforation risk.
Main Methods:
- Retrospective observational study of 1691 patients with active fixation pacing/defibrillator leads.
- Analysis of 14 patients with clinically relevant RV perforation.
Main Results:
- Lead slack score, change in lead slack height, and lead width were independent predictors of RV perforation in multivariate analysis.
- Left ventricular ejection fraction also showed a significant association.
Conclusions:
- Fluoroscopic predictors of RV perforation are identifiable during implantation.
- Identifying these predictors may help prevent complications associated with active-fixation leads.
Introduction:
Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking.
Methods:
We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter-defibrillator leads were included in the study.
Results:
Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066-12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011-1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120-1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910-1.088; p = .032) were independent predictors of RV perforation.
Conclusion:
Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active-fixation leads.
