TY - JOUR
T1 - Apical versus Non-Apical Lead
T2 - Is ICD Lead Position Important for Successful Defibrillation?
AU - Amit, Guy
AU - Wang, Jia
AU - Connolly, Stuart J.
AU - Glikson, Michael
AU - Hohnloser, Stephan
AU - Wright, David J.
AU - Brachmann, Johannes
AU - Defaye, Pascal
AU - Neuzner, Joerg
AU - Mabo, Philippe
AU - VanErven, Liselot
AU - Vinolas, Xavier
AU - O'Hara, Gilles
AU - Kautzner, Josef
AU - Appl, Ursula
AU - Gadler, Fredrik
AU - Stein, Kenneth
AU - Konstantino, Yuval
AU - Healey, Jeff S.
N1 - Publisher Copyright:
© 2016 Wiley Periodicals, Inc.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - ICD Lead Position and Outcome Introduction We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position. Methods and Results The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity score matched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location. Conclusion We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead.
AB - ICD Lead Position and Outcome Introduction We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position. Methods and Results The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity score matched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location. Conclusion We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead.
KW - cardiac resynchronization therapy
KW - defibrillation safety margin
KW - defibrillation testing
KW - failed shocks
KW - implantable cardioverter defibrillator
KW - inappropriate shocks
KW - right ventricular lead
UR - http://www.scopus.com/inward/record.url?scp=84962694468&partnerID=8YFLogxK
U2 - 10.1111/jce.12952
DO - 10.1111/jce.12952
M3 - Article
AN - SCOPUS:84962694468
SN - 1045-3873
VL - 27
SP - 581
EP - 586
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 5
ER -