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Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture
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| Title: | Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture |
| Authors: | Watanabe, Masaya Browse this author | | Yokoshiki, Hisashi Browse this author →KAKEN DB | | Mitsuyama, Hirofumi Browse this author | | Mizukami, Kazuya Browse this author | | Tenma, Taro Browse this author | | Kamada, Rui Browse this author | | Takahashi, Masayuki Browse this author | | Matsui, Yoshiro Browse this author →KAKEN DB | | Anzai, Toshihisa Browse this author |
| Keywords: | cephalic cutdown | | defibrillator lead | | extrathoracic puncture | | lead failure | | subclavian crush syndrome |
| Issue Date: | Oct-2018 |
| Publisher: | John Wiley & Sons |
| Journal Title: | Journal of arrhythmia |
| Volume: | 34 |
| Issue: | 5 |
| Start Page: | 541 |
| End Page: | 547 |
| Publisher DOI: | 10.1002/joa3.12107 |
| Abstract: | Background: As the transvenous defibrillator lead is fragile and its failure may cause a life-threatening event, reliable insertion techniques are required. While the extrathoracic puncture has been introduced to avoid subclavian crush syndrome, the reports on the long-term defibrillator lead survival using this approach, especially the comparison with the cephalic cutdown (CD), remain scarce. We aimed to evaluate the long-term survival of the transvenous defibrillator lead inserted by the extrathoracic subclavian puncture (ESCP) compared with CD. Methods: Between 1998 and 2011, 324 consecutive patients who underwent an implantable cardioverter-defibrillator (ICD) implantation in Hokkaido University Hospital were included. ICD leads were inserted by CD from 1998 to 2003 and by contrast venography-guided ESCP thereafter. Lead failure was defined as a nonphysiologic high-rate oversensing with abnormal lead impedance or highly elevated sensing and pacing threshold. Results: Of 324 patients, CD was used in 37 (11%) and ESCP in 287 patients (89%). During the median follow-up of 6.2 years (IQR:3.2-8.3), 7 leads (2 in CD and 5 leads in ESCP group) failed. All patients with lead failure in ESCP group were implanted with either SJM Riata (n = 1) or Medtronic Fidelis lead (n = 4). Five-year lead survival was 93.8% (CI95%:77.3-98.4%) in CD compared with 99.1% (CI95%:96.6-99.8%) in ESCP group (P = 0.903). Univariate Cox regression analysis showed that the use of Fidelis or Riata lead was the strong predictor of the ICD lead failure (HR 13.8, CI95%:2.9-96.5; P = 0.001). Conclusions: Contrast venography-guided extrathoracic puncture ensures the reliable long-term survival in the transvenous defibrillator leads. |
| Rights: | http://creativecommons.org/licenses/by-nc/4.0/ |
| Type: | article |
| URI: | http://hdl.handle.net/2115/72045 |
| Appears in Collections: | 北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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Submitter: 渡邉 昌也
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