Author + information
- Muhammad Rizwan Afzal,
- Nancy Matre,
- Sarah Horner,
- Dilesh Patel,
- Mahmoud Houmsse,
- Emile Daoud,
- Steven Kalbfleisch,
- Jaret Tyler,
- Toshimasa Okabe,
- John Hummel,
- Raul Weiss and
- Ralph Augostini
Background: Lead dislodgement is a common complication of cardiac implantable electronic devices (CIEDs). As a quality initiative at our tertiary care center, an intramural protocol was developed to reduce the risk of lead dislodgment.
Methods: The protocol involved i) inserting a straight stylet down the right atrial lead after fixation and applying a little bit of pressure, ii) visualizing the right atrial and right ventricle leads during respiration to determine if there is enough slack and iii) encouraging the patient to take a deep breath and cough while pacing at minimum pacing threshold to see if there is loss of capture. Electronic medical records were reviewed to determine the demographic factors, clinical characteristics and incidence of lead dislodgment during first 24 hours after implantation. Fisher exact test was used to compare the incidence of lead dislodgement in two groups. During 27 months prior to the implementation of the protocol, a total of 3320 (44 % ICDs) leads were implanted (Control group). During 10 months after the protocol was started, a total of 1305 leads (53 % ICDs) were implanted (Intervention group).
Results: There was no significant difference in the demographic factors and clinical characteristics of the two groups. Protocol compliance was > 90 %. There were 28 lead dislodgements (28/3320 = 0.84 %) before and 5 (5/1305 = 0.38 %) after the implementation of the protocol. The protocol significantly reduced the incidence of lead dislodgement (P = 0.04). Univariate analysis showed that old age, female sex, increased body mass index and lead extraction during the same procedure were predictors for increased risk of lead dislodgment.
Conclusions: Maneuvers performed to stress the CIED leads during implantation reduces the risk of lead dislodgment.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: Devices 2
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1149-082
- 2017 American College of Cardiology Foundation