Koike Toshiharu, Shoda Morio, Ejima Koichiro, Yagishita Daigo, Suzuki Atsushi, Hasegawa Shun, Kataoka Shohei, Yazaki Kyoichiro, Higuchi Satoshi, Kanai Miwa, Yamaguchi Junichi
Department of Cardiology Tokyo Women's Medical University 8-1 Kawada-cho, Shinjuku-ku Tokyo 162-8666 Japan.
Clinical Research Division for Heart Rhythm Management, Department of Cardiology Tokyo Women's Medical University 162-8666 Tokyo 8-1 Kawada-cho, Shinjuku-ku Japan.
J Arrhythm. 2023 Mar 26;39(3):454-463. doi: 10.1002/joa3.12843. eCollection 2023 Jun.
The long-term relationship between fracture-prone implantable cardioverter-defibrillator (ICD) leads and poor prognosis remains unclear in Japanese patients.
We conducted a retrospective review of the records of 445 patients who underwent implantation of advisory/Linox leads (Sprint Fidelis, 118; Riata, nine; Isoline, 10; Linox S/SD, 45) and non-advisory leads (Endotak Reliance, 33; Durata, 199; Sprint non-Fidelis, 31) between January 2005 and June 2012 at our hospital. The primary outcomes were all-cause mortality and ICD lead failure. The secondary outcomes were cardiovascular mortality, heart failure (HF) hospitalization, and the composite outcome of cardiovascular mortality and HF hospitalization.
During the follow-up period (median, 8.6 [4.1-12.0] years), there were 152 deaths: 61 (34%) in patients with advisory/Linox leads and 91 (35%) in those with non-advisory leads. There were 32 ICD lead failures: 27 (15%) in patients with advisory/Linox leads and five (2%) in those with non-advisory leads. Multivariate analysis for ICD lead failure demonstrated that the advisory/Linox leads had a 6.65-fold significantly greater risk of ICD lead failure than non-advisory leads. Congenital heart disease (hazard ratio 2.51; 95% confidence interval 1.08-5.83; = .03) could also independently predict ICD lead failure. Multivariate analysis for all-cause mortality demonstrated no significant association between advisory/Linox leads and all-cause mortality.
Patients who have implanted fracture-prone ICD leads should be carefully followed up for ICD lead failure. However, these patients have a long-term survival rate comparable with that of patients with non-advisory ICD leads in Japanese patients.
在日本患者中，易发生骨折的植入式心脏复律除颤器（ICD）导线与不良预后之间的长期关系尚不清楚。
我们对2005年1月至2012年6月期间在我院接受咨询/Linox导线（美敦力Sprint Fidelis，118例；Riata，9例；Isoline，10例；Linox S/SD，45例）和非咨询导线（圣犹达Endotak Reliance，33例；美敦力Durata，199例；美敦力Sprint非Fidelis，31例）植入的445例患者的记录进行了回顾性分析。主要结局为全因死亡率和ICD导线故障。次要结局为心血管死亡率、心力衰竭（HF）住院率以及心血管死亡率和HF住院率的复合结局。
在随访期间（中位时间为8.6[4.1 - 12.0]年），共有152例死亡：咨询/Linox导线患者中有61例（34%），非咨询导线患者中有91例（35%）。发生32例例ICICD导线故障：咨询/Linox导线患者中有27例（15%），非咨询导线患者中有5例（2%）。对ICD导线故障进行多因素分析显示，咨询/Linox导线发生ICD导线故障的风险比非咨询导线显著高6.65倍。先天性心脏病（风险比2.51；95%置信区间1.08 - 5.83；P = 0.03）也可独立预测ICD导线故障。对全因死亡率进行多因素分析显示，咨询/Linox导线与全因死亡率之间无显著关联。
植入易发生骨折的ICD导线的患者应密切随访ICD导线故障情况。然而，在日本患者中，这些患者的长期生存率与植入非咨询ICD导线的患者相当。
