Abstract 12056: Improved Atrioventricular Valve Integrity With Use of the Newer 4.1 French Diameter Pacing Lead in the Young With and Without Congenital Heart
Background: Current 5-7Fr diameter pacing leads (PL) adversly affect arioventricular valve (AVV) integrity with insufficiency (I) and stenosis (S) in 22-30% of patients (pts), causing symptoms and hindering extraction. Although chronic threshold/sensing performances of the newer 4.1Fr diameter PL (Medtronic M3830) (released 2005) have been reported, comparative chronic AVV effects among pts with and without congenital heart (CHD) are largely unknown. Figure shows diameter differences of ventricular PL in 2 pts both with Transposition of Great Arteries (DTGA)/Mustard procedure. This study compares AVV (tricuspid and mitral depending on CHD) effects after ventricular PL implanted among comparable pts with and without CHD.
Methods: 134 pts with ventricular PL implants were divided into two groups based on PL: Group 1 (n=66, M3830), Group 2 (n= 68, 5-7Fr models). All PL were steroid-eluting, active fixation designs. Repaired CHD included septal defects, Tetralogy of Fallot and DTGA. Pre- and up to 8 year post-implant clinical findings and transthoracic ECHO/Doppler studies were reviewed. AVV I/S were classified as none/trace, Mild (MI), moderate (MO) and severe. Statistical significance was defined at p≤0.05.
Results: Up to 8y post-implant AVV data/clinical findings were available on all 66 pts in Group 1 (mean follow-up 38±22m) and all 68 pts from Group 2 (mean follow-up 32±27m) (p=NS). Pt ages (mean 18 vs 21y), presence of CHD, and AVV morphologies were comparable between Groups. Pre-existing MI/MO AVVI was found in 16% of Group 1 and 19% of Group 2 pts (p=NS). Post PL-implant, 7 Group 1 pts (11%) had worsening of AVV but no symptoms while 20 Group 2 pts (29%) developed new onset or worsening of AVVI with symptoms (p≤0.019). Neither group showed pre- or post-implant AVVS.
Conclusion: The newer 4.1 Fr M3830 PL offers improved clinical benefits and maintains better AVV integrity compared with standard larger diameter PL and should be considered especially in younger patients.
- © 2013 by American Heart Association, Inc.