Witt Christoffer Tobias, Ng Kam Chuen Marie Jennyfer, Kronborg Mads Brix, Kristensen Jens, Gerdes Christian, Nielsen Jens Cosedis
Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Department of Cardiology, Trent Cardiac Centre, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
J Interv Card Electrophysiol. 2022 Jan;63(1):69-75. doi: 10.1007/s10840-021-00947-7. Epub 2021 Feb 1.
Left ventricular (LV) lead complications in cardiac resynchronization therapy are challenging and poorly reported. We aimed to establish prevalence, causes and outcomes of LV lead complications requiring re-intervention.
We analysed the rate of complications in 2551 consecutive patients who received a transvenous de novo LV lead as part of a cardiac resynchronization therapy device between 2000 and 2018. LV lead complications requiring re-intervention were identified; those due to infection were excluded. Patient, procedural and device characteristics, and outcomes were examined for non-infective LV lead complications requiring re-intervention.
During a median of 4.7 years, 142 (5.6%) patients required re-intervention for non-infective LV lead complications with a decrease from 10.7% between 2000 and 2004, 8.7% between 2005 and 2009, 3.2% between 2010 and 2014 to 3.2% after 2014. The most common complications were LV lead displacement (50%), high pacing threshold (28%) and phrenic nerve stimulation (15%). Of the complications, 79 (56%) occurred within 90 days post-implant and 63 (44%) later. At the end of the study period, 132/142 patients (93%) had a functional LV lead. Lead re-intervention was associated with higher risk of complications (20%), but no increase in mortality (P = 0.19). Quadripolar leads had longer longevity and lower risk of complications compared with unipolar and bipolar LV leads.
A small but significant proportion of patients required LV lead re-intervention for complications following de novo implant. Lead displacement accounted for half of the re-interventions. Re-intervention was associated with a higher complication rate, but 92% of these patients had functional LV leads at the end of follow-up.
心脏再同步治疗中左心室（LV）导线并发症具有挑战性且报道较少。我们旨在确定需要再次干预的LV导线并发症的发生率、原因及结局。
我们分析了2000年至2018年间连续2551例接受经静脉植入全新LV导线作为心脏再同步治疗设备一部分的患者的并发症发生率。确定了需要再次干预的LV导线并发症；排除了感染所致的并发症。对需要再次干预的非感染性LV导线并发症的患者、手术及设备特征以及结局进行了检查。
在中位4.7年期间，142例（5.6%）患者因非感染性LV导线并发症需要再次干预，发生率从2000年至2004年的10.7%、2005年至2009年的8.7%、2010年至2014年的3.2%降至2014年后的3.2%。最常见的并发症是LV导线移位（50%）、高起搏阈值（28%）和膈神经刺激（15%）。其中，79例（56%）并发症发生在植入后90天内，63例（44%）发生在之后。在研究期结束时，142例患者中有132例（93%）的LV导线功能正常。导线再次干预与更高的并发症风险（20%）相关，但死亡率未增加（P = 0.19）。与单极和双极LV导线相比，四极导线的使用寿命更长，并发症风险更低。
一小部分但比例可观的患者在首次植入后因并发症需要进行LV导线再次干预。导线移位占再次干预的一半。再次干预与更高的并发症发生率相关，但这些患者中有92%在随访结束时LV导线功能正常。
