Abstract 2437: Acute Lead Dislodgements in Patients Undergoing ICD and CRT Implants: A Report From the ACC-NCDR ICD Registry
Introduction: Early reports regarding the prevalence of ICD and CRT acute lead dislodgements have been based on single center experiences and limited number of patients studied. We hypothesize that acute lead dislodgements are associated with specific adjusted patient demographics as well as the implanter’s level of experience.
Methods: Patients in the NCDR ICD Registry between April, 2006 and March, 2008 were included in the analysis. Individuals with a previous ICD were excluded. Acute lead dislodgements were defined as those occurring during the periprocedural hospitalization that required lead repositioning.
Results: Among 226,764 patients, acute lead dislodgements occurred with a prevalence of 1.1% and represented one of the most common types of adverse events reported. Individuals with a higher risk for acute lead dislodgements included those who were older (68.5 vs. 67.5 yrs, p<0.01), female (29.9% vs. 27.0%, p<0.01), and have a history atrial fibrillation (35.9% vs. 31.3%, p<0.01), chronic lung disease (25.6% vs. 22.8%, p<0.01), cerebrovascular disease (16.7% vs. 14.5%, p<0.01), lower ejection fractions (26.8% vs. 27.5%, p<0.01) and nonischemic cardiomyopathy (37.3% vs. 32.0%, p<0.01). Individuals receiving biventricular devices were particularly susceptible to lead dislodgements as compared to single or dual chamber ICDs (p<0.01). Patients whose implanting physicians were either board certified in electrophysiology (EP) or had completed an EP fellowship were less likely to have experienced an acute lead dislodgement (p<0.01). More importantly, individuals who experienced an acute lead dislodgement had a higher risk of more serious adverse events including cardiac arrest, cardiac perforation, hematoma, pericardial tamponade, device infection, pneumothorax and in-hospital death (all p<0.01). These findings remained statistically significant after adjusting for various potential confounders.
Conclusions: Acute lead dislodgements are among the most common adverse events and occur with greater frequency in women, individuals with more comorbidities and those undergoing implants by non-EP trained implanters. These events are associated with more serious adverse sequelae including cardiac arrest and in-hospital death.