Abstract 14895: The Female Sex and BMI Are Significant Independent Predictor of Pacemaker Lead Movement With Standing After Pacemaker Implantation
Background: Pacemaker lead dislodgement is a rare but serious complication of pacemaker implantation, but information about the causes of lead displacement is scarce. Empirically, when patients take an upright position after pacemaker implantation, the position of the generator drops caudally, and leads will be retracted, which can result in lead dislodgement. This seems to be prominent in females with high body mass index (BMI), but this phenomenon has not been studied.
Hypothesis: We assessed the hypothesis that the BMI and female sex contributes to the degree of lead movement with standing after pacemaker implantation.
Methods: We retrospectively enrolled 189 consecutive patients who underwent DDD pacemaker implantation from year 2009 to 2011 at our hospital. The degree of the lead movement was assessed by reviewing the chest radiograph of the patients. The atrial leads in the lateral view were selected for analysis due to minimal 3D configuration. The length from the innominate-SVC junction to the tip of the lead was measured. The difference between the supine film and the upright film was defined as the length of lead movement due to standing. Thirty three patients were excluded due to lack of assessable chest radiograph, or atrial lead position other than right atrial appendage.
Results: The study population consisted of 156 patients (64 male, average age 78±10 years old). The average length of lead movement was 24±12mm. In correlation analysis, female sex (r=0.21, p=0.008), BMI (r=0.35, p<0.001), and active (as opposed to passive) fixation lead (r=0.26, p=0.001) were significantly correlated with the length of lead movement. In multiple regression analysis, female sex (B=4.73, β=0.20, p=0.008) and BMI (B=0.90. β=0.30, p<0.001) were shown to be independent factors associated with the length of lead movement.
Conclusions: In conclusion, the female sex and the BMI were shown to independently correlate with the length of lead movement with standing in patients undergoing pacemaker implantation, and may lead to increase in the risk of pacemaker lead dislodgement.
- © 2013 by American Heart Association, Inc.