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

TitleLong-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy
Publication TypeJournal Article
Year of Publication2016
AuthorsHerman, AR, Gardner, M, Steinberg, C, Yeung-Lai-Way, JA, Healey, JS, Leong-Sit, P, Krahn, AD, Chakrabarti, S
JournalHeart Rhythm
Volume13
Issue10
Start Page1964-70
Abstract

Background

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.

DOI10.1016/j.hrthm.2016.06.021