Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy

Trends in implantable cardioverter defibrillator and cardiac resynchronisation therapy lead parameters for patients with arrhythmogenic and dilated cardiomyopathies

“…Interestingly, when this group was analysed according to lead position, for those placed on the septum there was a small but significant deterioration in R wave, while those in non-septal sites (4 out of 5 at the apex) showed a small but significant increase in R wave over time. This contrasts with the findings of Herman et al., who reported no change in R wave in septally-positioned leads, though a deterioration for apical leads [4]. Our findings were unexpected, but together with those of Herman et al., suggest that while sensing may change slightly over the medium term, and lead position may affect this, the magnitude of change is small and therefore may not be of clinical significance.…”

“…The lack of change in RV threshold indices in the ARVC group is concordant with other published reports in which either no, or minimal change in threshold was observed [4,11]. The DCM group on the other hand experienced a moderate increase in RV and LV threshold parameters over medium term follow up.…”

“…We found a highly significant difference of moderate magnitude in R wave amplitude between patients with ARVC and DCM at baseline. The only other study to date to compare baseline characteristics between patients with ARVC and a comparator group found no difference [4]. This is difficult to explain, but the findings below do not support this being related to disease process.…”

Optimizing RV lead position in RV cardiomyopathy: Are we there yet?

“…Contrary to prior reports [5], the authors found that the RV leads in the septal position had lower sensing during follow up compared to RV apical leads, which in fact had improved sensing. Right ventricular septum is characteristically spared in ARVC and often thought to be the best location for lead deployment due to its stable sensing parameters.…”

The Cardiac Society of Australia and New Zealand Position Statement on the Diagnosis and Management of Arrhythmogenic Right Ventricular Cardiomyopathy (2019 Update)

“…The latter may occur in up to 20% by 10 years [21]. With progressive right ventricular scarring, R wave amplitude sensing may become significantly impaired over time in patients with ARVC [22]. Lead thromboembolism may raise pulmonary pressure and potentially worsen right ventricular function [23].…”