Apical versus Non-Apical Lead: Is ICD Lead Position Important for Successful Defibrillation?
Por:
Amit, G, Wang, J, Connolly, SJ, Glikson, M, Hohnloser, S, Wright, DJ, Brachmann, J, Defaye, P, Neuzner, J, Mabo, P, Vanerven, L, Vinolas, X, O'Hara, G, Kautzner, J, Appl, U, Gadler, F, Stein, K, Konstantino, Y, Healey, JS
Publicada:
1 may 2016
Resumen:
ICD Lead Position and Outcome. Introduction: We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position.
Methods and Results: The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity scorematched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location.
Conclusion: We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead.
Filiaciones:
Amit, G:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Hamilton, ON, Canada
Wang, J:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Hamilton, ON, Canada
Connolly, SJ:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Hamilton, ON, Canada
Glikson, M:
Chaim Sheba Med Ctr, Leviev Heart Ctr, IL-52621 Tel Hashomer, Israel
Hohnloser, S:
Goethe Univ Frankfurt, D-60054 Frankfurt, Germany
Wright, DJ:
Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
Brachmann, J:
Klinikum Coburg GbmH, Coburg, Germany
Defaye, P:
CHU Hop Michallon, Grenoble, France
Neuzner, J:
Klinikum Kassel, Kassel, Germany
Mabo, P:
Ctr Hosp Univ, Rennes, France
Vanerven, L:
Leiden Univ, Med Ctr, Leiden, Netherlands
Vinolas, X:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
O'Hara, G:
Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada
Kautzner, J:
Inst Clin & Expt Med, Prague, Czech Republic
Appl, U:
Boston Sci, Minneapolis, MN USA
Boston Sci, Brussels, Belgium
Gadler, F:
Karolinska Inst, Stockholm, Sweden
Stein, K:
Boston Sci, Minneapolis, MN USA
Boston Sci, Brussels, Belgium
Konstantino, Y:
Ben Gurion Univ Negev, Soroka Med Ctr, IL-84105 Beer Sheva, Israel
Healey, JS:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Hamilton, ON, Canada
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