Roberts Hilary, Matheson Kara, Sapp John, Gardner Martin, Gray Chris, AbdelWahab Amir, Lee David, MacIntyre Ciorsti, Parkash Ratika
Department of Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.
Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Heart Rhythm O2. 2023 May 20;4(7):417-426. doi: 10.1016/j.hroo.2023.05.002. eCollection 2023 Jul.
Electrical lead abnormalities (ELAs) can result in device malfunction, leading to significant morbidity in patients with cardiac implantable electronic devices (CIEDs).
We sought to determine the prevalence and management of ELAs in patients with CIEDs.
This was a retrospective cohort study of patients implanted with a CIED between 2012 and 2019 at a tertiary care center. The primary outcome was ELA defined as increased capture threshold (≥2× implantation value), decreased sensing (≤0.5 implantation value), change in impedance (>50% over 3 months), or nonphysiologic potentials. A secondary outcome of device clinic utilization was also collected.
There were 2996 unique patients (35% female) included with 4600 leads (57% Abbott, 43% Medtronic). ELAs were observed in 135 (3%) leads, including 124 (92%) Abbott and 10 (7%) Medtronic leads (hazard ratio 9.25, .001). Mean follow-up was 4.5 ± 2.2 years. ELAs were associated smaller lead French size, atrial location, and Abbott leads. Lead revision was required in 28% of cases. Patients with lead abnormalities had 38% more in-clinic visits per patient year of follow-up compared with those without ( .001).
ELAs were more frequent in certain models, which increased rates of revision and follow-up. Identification of factors that mitigate these abnormalities to improve lead performance are required to improve care for these devices and provide efficient healthcare.
电极导线异常（ELAs）可导致设备故障，从而使心脏植入式电子设备（CIEDs）患者出现严重发病情况。
我们试图确定CIEDs患者中ELAs的患病率及处理情况。
这是一项对2012年至2019年在一家三级医疗中心植入CIED的患者进行的回顾性队列研究。主要结局是ELA，定义为捕获阈值增加（≥植入值的2倍）、感知降低（≤植入值的0.5倍）、阻抗变化（3个月内>50%）或非生理性电位。还收集了设备门诊利用情况的次要结局。
共纳入2996例独特患者（35%为女性），有4600根导线（57%为雅培，43%为美敦力）。在135根（3%）导线中观察到ELAs，其中包括124根（92%）雅培导线和10根（7%）美敦力导线（风险比9.25，P<0.001）。平均随访时间为4.5±2.2年。ELAs与较小的导线法式规格、心房位置和雅培导线相关。28%的病例需要进行导线翻修。与无导线异常的患者相比，有导线异常的患者在随访的每年中门诊就诊次数多38%（P<0.001）。
某些型号中ELAs更常见，这增加了翻修率和随访率。需要确定减轻这些异常以改善导线性能的因素，以改善这些设备的护理并提供高效的医疗保健。
