Long-Term Implantable Cardioverter Defibrillator Lead Dysfunction After Left Ventricular Assist Device Implantation

TL;DR

This study found that most patients with heart devices experience long-term issues with defibrillator leads, with later issues being more likely to persist.

Contribution

The study reports long-term outcomes of ICD lead dysfunction after LVAD implantation and identifies a novel predictor of persistent dysfunction.

Findings

ICD lead dysfunction occurred in 72.9% of patients after LVAD implantation.

Persistent dysfunction was observed in 67.7% of dysfunctional leads.

Lead dysfunction occurring later than 2.1 months after LVAD implantation is an independent risk factor for persistent dysfunction.

Abstract

Implantable cardioverter defibrillator (ICD) lead dysfunction after left ventricular assist device (LVAD) implantation can occur, but only short-term outcomes have been reported.

We aimed to evaluate the long-term incidence, characteristics, and predictors of persistent ICD lead dysfunction after LVAD implantation.

This was a retrospective multicenter study. All patients with a transvenous ICD lead at the time of LVAD implantation between January 1, 2011, and December 31, 2023, were enrolled. The primary endpoint was lead dysfunction. Risk factors for persistent compared to temporary lead dysfunction using a logistic analysis were determined.

One hundred and seventy patients (mean age: 48.0 ± 12.7 years) were analyzed. The median follow-up period was 46.2 (Q1-Q3: 32.3-61.4) months. Lead dysfunction was observed in 124 leads (72.9%), of which 60.4% (N = 75) occurred within a year after LVAD implantation. Of the 124 lead dysfunctions, 84 (67.7%) showed persistent dysfunction and 40 (32.3%) were temporary. Lead dysfunction occurring later than 2.1 months after LVAD implantation was a risk factor for persistent lead dysfunction (area under the curve: 0.673). Multivariable analysis identified lead dysfunction occurring later than 2.1 months after LVAD implantation as an independent risk factor for persistent lead dysfunction (OR: 4.67; 95% CI: 2.05-10.94; P < 0.001).

In patients undergoing LVAD implantation, ICD lead dysfunction was observed in 72.9% after a mean follow-up of 46.2 months, of which two-thirds had persistence lead dysfunction. Later occurrence of lead dysfunction (>2 months after implant) may be a risk factor for persistent lead dysfunction.

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