Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications

Chance M. Witt, Charles J. Lenz, Henry H. Shih, Elisa Ebrille, Andrew N. Rosenbaum, Martin van Zyl, Htin Aung, 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

9 Citations (Scopus)

Abstract

Introduction: Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. Methods and results: All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005). Conclusions: Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Atrial Fibrillation
Lead
Mortality
Thorax
Incidence

Keywords

  • Atrial fibrillation
  • Cardiomyopathy
  • Complications
  • Heart failure
  • Mortality
  • Ventricular pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Witt, C. M., Lenz, C. J., Shih, H. H., Ebrille, E., Rosenbaum, A. N., van Zyl, M., ... Mcleod, C. J. (Accepted/In press). Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.13256

Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. / Witt, Chance M.; Lenz, Charles J.; Shih, Henry H.; Ebrille, Elisa; Rosenbaum, Andrew N.; van Zyl, Martin; Aung, Htin; 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 Cardiovascular Electrophysiology, 2017.

Research output: Contribution to journalArticle

Witt, Chance M. ; Lenz, Charles J. ; Shih, Henry H. ; Ebrille, Elisa ; Rosenbaum, Andrew N. ; van Zyl, Martin ; Aung, Htin ; Manocha, Kevin K. ; Deshmukh, Abhishek J. ; Hodge, David O. ; Mulpuru, Siva ; Cha, Yong-Mei ; Espinosa, Raul Emilio ; Asirvatham, Samuel J ; Mcleod, Christopher J. / Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. In: Journal of Cardiovascular Electrophysiology. 2017.
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abstract = "Introduction: Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. Methods and results: All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40{\%} ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24{\%} vs. 31{\%}, P = 0.02). In patients with greater than 40{\%} pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49{\%} vs. 34{\%}, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4{\%} vs. 2{\%}, P = 0.005) and need for revision (8{\%} vs. 5{\%}, P = 0.005). Conclusions: Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided.",
keywords = "Atrial fibrillation, Cardiomyopathy, Complications, Heart failure, Mortality, Ventricular pacing",
author = "Witt, {Chance M.} and Lenz, {Charles J.} and Shih, {Henry H.} and Elisa Ebrille and Rosenbaum, {Andrew N.} and {van Zyl}, Martin and Htin Aung 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 ventricular pacemaker lead position is associated with differences in long-term outcomes and complications

AU - Witt, Chance M.

AU - Lenz, Charles J.

AU - Shih, Henry H.

AU - Ebrille, Elisa

AU - Rosenbaum, Andrew N.

AU - van Zyl, Martin

AU - Aung, Htin

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 - 2017

Y1 - 2017

N2 - Introduction: Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. Methods and results: All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005). Conclusions: Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided.

AB - Introduction: Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. Methods and results: All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005). Conclusions: Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided.

KW - Atrial fibrillation

KW - Cardiomyopathy

KW - Complications

KW - Heart failure

KW - Mortality

KW - Ventricular pacing

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DO - 10.1111/jce.13256

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