Christie Simon, El Tobgy Nada, Seifer Colette M, Khoo Clarence
Max Rady College of Medicine, Faculty of Health Sciences University of Manitoba Winnipeg Canada.
J Arrhythm. 2022 Jun 14;38(4):615-621. doi: 10.1002/joa3.12745. eCollection 2022 Aug.
Cardiac Implantable Electronic Devices (CIED) include pulse generators and leads. In some implanting centers, it is a common practice to combine devices with leads from different companies. Case series have reported episodic high-impedance changes in Boston Scientific CIEDs with competitor leads. We investigated the incidence of high-impedance abnormalities in matched versus mismatched Boston Scientific Accolade pacemakers.
A retrospective chart review identified all consecutive Boston Scientific Accolade pacemakers implanted between January 2017 and June 2019 at a Canadian tertiary care center. The primary outcome was the occurrence of transient, high-impedance changes which resulted in a switch to unipolar pacing/sensing in the absence of any other identifiable lead issue. Fisher exact tests (two-tailed, = .05) were used to compare the incidence of outcomes in matched versus mismatched systems.
514 Boston Scientific Accolade pacemakers were associated with 882 individual leads. The primary outcome occurred with 21 leads (20 Medtronic and 1 Abbott), associated with occasional pacing inhibition, presyncope, and/or early surgical revision. Mismatched lead-device pairs were significantly associated with CIED malfunction compared to matched lead-device pairs (3.3% vs. 0%, = .0019). The median time from implant to unipolar safety switch was 12.4 months. The median follow-up time was 21.6 months.
Use of mismatched leads with a Boston Scientific Accolade device was associated with an increased risk of undesirable changes in sensing polarity with occasional inappropriate pacing inhibition. Awareness of this interaction can allow for the institution of appropriate programming remedies and may increase scrutiny of the use of mismatched CIED systems.
心脏植入式电子设备（CIED）包括脉冲发生器和导线。在一些植入中心，将不同公司的设备与导线组合使用是常见做法。病例系列报道了波士顿科学公司的CIED与竞争对手的导线出现间歇性高阻抗变化。我们调查了匹配与不匹配的波士顿科学公司Accolade起搏器中高阻抗异常的发生率。
一项回顾性图表审查确定了2017年1月至2019年6月期间在加拿大一家三级护理中心植入的所有连续的波士顿科学公司Accolade起搏器。主要结局是出现短暂的高阻抗变化，导致在没有任何其他可识别的导线问题的情况下切换到单极起搏/感知。使用Fisher精确检验（双侧，α = 0.05）比较匹配与不匹配系统中结局的发生率。
514台波士顿科学公司Accolade起搏器与882根单独的导线相关联。主要结局发生在21根导线上（20根美敦力导线和1根雅培导线），伴有偶尔的起搏抑制、先兆晕厥和/或早期手术翻修。与匹配的导线-设备对相比，不匹配的导线-设备对与CIED故障显著相关（3.3%对0%，P = 0.0019）。从植入到单极安全切换的中位时间为12.4个月。中位随访时间为21.6个月。
将不匹配的导线与波士顿科学公司Accolade设备一起使用与感知极性出现不良变化的风险增加相关，偶尔会出现不适当的起搏抑制。意识到这种相互作用可以采取适当的程控补救措施，并可能加强对不匹配CIED系统使用的审查。
