Lead-related complications after DDD pacemaker implantation

Dębski, Maciej; Ulman, Mateusz; Ząbek, Andrzej; Boczar, Krzysztof; Haberka, Kazimierz; Kuniewicz, Marcin; Lelakowski, Jacek; Małecka, Barbara

doi:10.5603/kp.a2018.0089

Cited by 18 publications

(15 citation statements)

References 25 publications

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“…The survival and lead -related complications in the present cohort have been studied previously. 9,14,15 The endpoints were the onset of permanent AF and all--cause mortality. The data used in the analysis included 1) patients' demographic baseline characteristics: age at implantation and sex; 2) index arrhythmia (primary electrocardiographic pacing indication): atrioventricular block (AVB) or sick sinus syndrome (SSS); 3) a history of AF prior to DDD PPM implantation; 4) position of the RV lead: apical or nonapical at discharge from the department; 5) time of permanent AF onset; and 6) date of death declared in the death certificate.…”

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confidence: 99%

Permanent atrial fibrillation in patients with a dual‑chamber pacemaker

Dębski¹,

Ulman²,

Ząbek³

et al. 2019

Kardiol Pol

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BACKGROUND Atrial fibrillation (AF) is thought to be a progressive arrhythmia. The impact of sex and position of right ventricular lead is not well recognized. Whilst nonparoxysmal AF compared with paroxysmal AF has been associated with increased mortality in the general population, its prognostic significance in patients with a dual -chamber (DDD) pacemaker is less clear. AIMS The aim of the study was to determine the incidence of permanent AF in patients with a DDD pacemaker, analyze the effect of selected baseline characteristics on permanent AF development, and examine the impact of permanent AF on patient survival. METHODS A retrospective cohort study included 3932 consecutive patients who underwent DDD pacing system implantation between 1984 and 2014. Follow -up was completed in August 2016. We included 3771 patients (96%) with post -operative follow -up and known vital status. Occurrence of permanent AF and all -cause mortality were the study endpoints. RESULTS During mean follow -up of 6.5 years, permanent AF occurred in 717 patients (19%). Sex (hazard ratio [HR], 1.316; 95% CI, 1.134-1.528, for men), age at implant (HR, 1.041; 95% CI, 1.033-1.049, 1-year increase), history of AF (HR, 3.521; 95% CI, 3.002-4.128) were independently associated with permanent AF development, whereas position of right ventricular lead (apical versus nonapical) and primary pacing indication (atrioventricular block versus sick sinus syndrome) were not related to permanent AF. Permanent AF was a significant risk factor for increased mortality (age-and sex -adjusted HR, 1.475; 95% CI, 1.294-1.682). CONCLUSIONS Permanent AF occurrence was independently predicted by advanced age at implant, male sex, and preexisting AF and associated with worse survival.

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confidence: 99%

Permanent atrial fibrillation in patients with a dual‑chamber pacemaker

Dębski¹,

Ulman²,

Ząbek³

et al. 2019

Kardiol Pol

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“…Increasing use of CIEDs is associated with increased complications, including lead dislodgements. Recently, numerous studies have evaluated the risk factors of lead dislodgements [ 6 , 13 , 17 , 18 ]. For instance, Dębski et al [ 17 ] showed that atrial lead position is an independent risk factor of lead dislodgement.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Early Cardiac Implantable Electronic Device Lead Dislodgement in the Elderly

Młynarski

Młynarska²,

Joniec³

et al. 2022

IJERPH

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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.

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“…The study by Dębski et al [4] is a timely article which discusses the issue of lead longevity. The authors should be congratulated for their work.…”

Section: Lead Failurementioning

confidence: 99%

“…In the near-term time horizon, we will likely use single chamber VDD and multicomponent dual chamber leadless pacemakers, as well as those which communicate with the subcutaneous implantable cardioverter-defibrillator [12]. Studies like this one from Dębski et al [4] on transvenous pacemaker leads will hopefully be less needed. Leads continue to be the "weakest link" in the chain of cardiac pacing [13] but it appears that we are at the brink of the much-needed next revolution in cardiac pacing -a world without leads!…”

Section: Lead Failurementioning

confidence: 99%