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

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• 作者：Adam R.M. Herman ; MSc^* ; Martin Gardner ; MD^&dagger ; ; Christian Steinberg ; MD^* ; John A. Yeung-Lai-Wah ; MD^* ; Jeff S. Healey ; MD^&Dagger ; ; Peter Leong-Sit ; MD^§ ; ; Andrew D. Krahn ; MD^* ; Santabhanu Chakrabarti ; MD^* ; ^{sc2009@mail.ubc.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Sensing ; Implantation ; Ventricular tachycardia ; Lead performance ; Cardiomyopathy ; Genetics
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：13
• 期：10
• 页码：1964-1970
• 全文大小：749 K

文摘

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive disease characterized by replacement of normal myocardium by fibrofatty tissue. The right ventricular (RV) apex is the typical target for implantable cardioverter-defibrillator (ICD) lead placement, raising concerns for suboptimal lead performance in medium- to long-term follow-up.

Objective

The purpose of this study was to determine whether placement of ICD leads at the RV apex was associated with performance deterioration of medium-term leads in ARVC patients compared to non-ARVC patients.

Methods

In this multicenter, retrospective, case-control study, ICD lead performance measures of R-wave, impedance, and pacing thresholds were compared at baseline and between 1-year and 5-year postimplantation follow-up using mixed-effect models adjusted for age and sex.

Results

One hundred one ARVC patients (49 women, age 50.6 ± 14.5 years) were compared to 56 control patients (37 women, age 48.2 ± 14.2 years). The mean difference in R wave between years 1 and 2 was –0.85 mV (P = .16) compared to a mean difference at years 5 and 6 of –1.85 mV (P = .02). There was no difference in impedance or pacing threshold or in lead lifetime between the 2 groups over 6-year follow-up (5.91 ± 3.89 years vs 5.48 ± 3.70 years, P = .239).

Conclusion

In ARVC patients with ICD leads implanted in the RV apex, ventricular sensing deteriorates significantly during medium-term follow-up. Septal RV lead placement should be explored as the first choice at implantation.