Right atrial lead fixation type and lead position are associated with significant variation in complications

Chance M. Witt, Charles J. Lenz, Henry H. Shih, Elisa Ebrille, Andrew N. Rosenbaum, Htin Aung, Martin van Zyl, Kevin K. Manocha, Abhishek J. Deshmukh, David O. Hodge, Siva Mulpuru, Yong-Mei Cha, Raul Emilio Espinosa, Samuel J Asirvatham, Christopher J. McLeod

Research output: Contribution to journalArticle

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Abstract

Purpose: Optimal atrial pacemaker lead position and fixation mechanism have not been determined with regard to effect on complications. We aimed to determine the association between atrial lead-related complications and varying atrial lead tip positions and lead fixation mechanisms. Methods: All patients who underwent dual-chamber pacemaker implant between 2004 and 2014 were retrospectively reviewed for atrial lead tip position and fixation type. Lead-related complications were assessed by electronic medical record review. Complication rates were compared at 1 year by chi-square analysis and at 5 years using a Kaplan-Meier analysis. Results: During the study period, 3451 patients (mean age 73.9, 53.4 % male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 %) vs. 6 (1.0 %), p = 0.005) and pericardiocentesis (46 (1.6 %) vs. 2 (0.3 %), p = 0.01) at 1 year compared to passive fixation leads. There was no difference in overall complication rates by fixation type (161 (5.7 %) vs. 29 (4.6 %), p = 0.26). Low atrial septal lead tip position was associated with a higher rate of lead dislodgement (10 (15.2 %)) compared to appendage (46 (1.6 %)), free wall (10 (2.1 %)), or high atrial septal (2 (4.7 %)) positions (p < 0.001). This difference was also reflected in a significantly increased need for lead revision and overall complications. A multivariate analysis which included potential confounders confirmed the association of active fixation leads with an increased rate of perforation-related complications (p = 0.03) and septal lead location with increased rates of dislodgement (p < 0.001). Conclusions: Active compared to passive lead fixation increases the risk for pericardial effusion requiring pericardiocentesis. There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Sep 9 2016

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Pericardiocentesis
Pericardial Effusion
Lead
Electronic Health Records
Kaplan-Meier Estimate
Multivariate Analysis
Incidence

Keywords

  • Complications
  • Fixation type
  • Lead position
  • Pacemaker lead

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Right atrial lead fixation type and lead position are associated with significant variation in complications. / Witt, Chance M.; Lenz, Charles J.; Shih, Henry H.; Ebrille, Elisa; Rosenbaum, Andrew N.; Aung, Htin; van Zyl, Martin; Manocha, Kevin K.; Deshmukh, Abhishek J.; Hodge, David O.; Mulpuru, Siva; Cha, Yong-Mei; Espinosa, Raul Emilio; Asirvatham, Samuel J; McLeod, Christopher J.

In: Journal of Interventional Cardiac Electrophysiology, 09.09.2016, p. 1-7.

Research output: Contribution to journalArticle

Witt, Chance M. ; Lenz, Charles J. ; Shih, Henry H. ; Ebrille, Elisa ; Rosenbaum, Andrew N. ; Aung, Htin ; van Zyl, Martin ; Manocha, Kevin K. ; Deshmukh, Abhishek J. ; Hodge, David O. ; Mulpuru, Siva ; Cha, Yong-Mei ; Espinosa, Raul Emilio ; Asirvatham, Samuel J ; McLeod, Christopher J. / Right atrial lead fixation type and lead position are associated with significant variation in complications. In: Journal of Interventional Cardiac Electrophysiology. 2016 ; pp. 1-7.
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abstract = "Purpose: Optimal atrial pacemaker lead position and fixation mechanism have not been determined with regard to effect on complications. We aimed to determine the association between atrial lead-related complications and varying atrial lead tip positions and lead fixation mechanisms. Methods: All patients who underwent dual-chamber pacemaker implant between 2004 and 2014 were retrospectively reviewed for atrial lead tip position and fixation type. Lead-related complications were assessed by electronic medical record review. Complication rates were compared at 1 year by chi-square analysis and at 5 years using a Kaplan-Meier analysis. Results: During the study period, 3451 patients (mean age 73.9, 53.4 {\%} male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 {\%}) vs. 6 (1.0 {\%}), p = 0.005) and pericardiocentesis (46 (1.6 {\%}) vs. 2 (0.3 {\%}), p = 0.01) at 1 year compared to passive fixation leads. There was no difference in overall complication rates by fixation type (161 (5.7 {\%}) vs. 29 (4.6 {\%}), p = 0.26). Low atrial septal lead tip position was associated with a higher rate of lead dislodgement (10 (15.2 {\%})) compared to appendage (46 (1.6 {\%})), free wall (10 (2.1 {\%})), or high atrial septal (2 (4.7 {\%})) positions (p < 0.001). This difference was also reflected in a significantly increased need for lead revision and overall complications. A multivariate analysis which included potential confounders confirmed the association of active fixation leads with an increased rate of perforation-related complications (p = 0.03) and septal lead location with increased rates of dislodgement (p < 0.001). Conclusions: Active compared to passive lead fixation increases the risk for pericardial effusion requiring pericardiocentesis. There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision.",
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author = "Witt, {Chance M.} and Lenz, {Charles J.} and Shih, {Henry H.} and Elisa Ebrille and Rosenbaum, {Andrew N.} and Htin Aung and {van Zyl}, Martin and Manocha, {Kevin K.} and Deshmukh, {Abhishek J.} and Hodge, {David O.} and Siva Mulpuru and Yong-Mei Cha and Espinosa, {Raul Emilio} and Asirvatham, {Samuel J} and McLeod, {Christopher J.}",
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T1 - Right atrial lead fixation type and lead position are associated with significant variation in complications

AU - Witt, Chance M.

AU - Lenz, Charles J.

AU - Shih, Henry H.

AU - Ebrille, Elisa

AU - Rosenbaum, Andrew N.

AU - Aung, Htin

AU - van Zyl, Martin

AU - Manocha, Kevin K.

AU - Deshmukh, Abhishek J.

AU - Hodge, David O.

AU - Mulpuru, Siva

AU - Cha, Yong-Mei

AU - Espinosa, Raul Emilio

AU - Asirvatham, Samuel J

AU - McLeod, Christopher J.

PY - 2016/9/9

Y1 - 2016/9/9

N2 - Purpose: Optimal atrial pacemaker lead position and fixation mechanism have not been determined with regard to effect on complications. We aimed to determine the association between atrial lead-related complications and varying atrial lead tip positions and lead fixation mechanisms. Methods: All patients who underwent dual-chamber pacemaker implant between 2004 and 2014 were retrospectively reviewed for atrial lead tip position and fixation type. Lead-related complications were assessed by electronic medical record review. Complication rates were compared at 1 year by chi-square analysis and at 5 years using a Kaplan-Meier analysis. Results: During the study period, 3451 patients (mean age 73.9, 53.4 % male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 %) vs. 6 (1.0 %), p = 0.005) and pericardiocentesis (46 (1.6 %) vs. 2 (0.3 %), p = 0.01) at 1 year compared to passive fixation leads. There was no difference in overall complication rates by fixation type (161 (5.7 %) vs. 29 (4.6 %), p = 0.26). Low atrial septal lead tip position was associated with a higher rate of lead dislodgement (10 (15.2 %)) compared to appendage (46 (1.6 %)), free wall (10 (2.1 %)), or high atrial septal (2 (4.7 %)) positions (p < 0.001). This difference was also reflected in a significantly increased need for lead revision and overall complications. A multivariate analysis which included potential confounders confirmed the association of active fixation leads with an increased rate of perforation-related complications (p = 0.03) and septal lead location with increased rates of dislodgement (p < 0.001). Conclusions: Active compared to passive lead fixation increases the risk for pericardial effusion requiring pericardiocentesis. There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision.

AB - Purpose: Optimal atrial pacemaker lead position and fixation mechanism have not been determined with regard to effect on complications. We aimed to determine the association between atrial lead-related complications and varying atrial lead tip positions and lead fixation mechanisms. Methods: All patients who underwent dual-chamber pacemaker implant between 2004 and 2014 were retrospectively reviewed for atrial lead tip position and fixation type. Lead-related complications were assessed by electronic medical record review. Complication rates were compared at 1 year by chi-square analysis and at 5 years using a Kaplan-Meier analysis. Results: During the study period, 3451 patients (mean age 73.9, 53.4 % male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 %) vs. 6 (1.0 %), p = 0.005) and pericardiocentesis (46 (1.6 %) vs. 2 (0.3 %), p = 0.01) at 1 year compared to passive fixation leads. There was no difference in overall complication rates by fixation type (161 (5.7 %) vs. 29 (4.6 %), p = 0.26). Low atrial septal lead tip position was associated with a higher rate of lead dislodgement (10 (15.2 %)) compared to appendage (46 (1.6 %)), free wall (10 (2.1 %)), or high atrial septal (2 (4.7 %)) positions (p < 0.001). This difference was also reflected in a significantly increased need for lead revision and overall complications. A multivariate analysis which included potential confounders confirmed the association of active fixation leads with an increased rate of perforation-related complications (p = 0.03) and septal lead location with increased rates of dislodgement (p < 0.001). Conclusions: Active compared to passive lead fixation increases the risk for pericardial effusion requiring pericardiocentesis. There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision.

KW - Complications

KW - Fixation type

KW - Lead position

KW - Pacemaker lead

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