J Korean Med Sci.  2010 Oct;25(10):1462-1466. 10.3346/jkms.2010.25.10.1462.

Long-term Prognosis of Left Ventricular Lead

• Park SJ
• Oh IY
• Yoon CH
• Park HE
• Choi EK
• Nam GB
• Choi KJ
• Kim YH
• Choi YS
• Oh S

• KMID: 2157850
• DOI: http://doi.org/10.3346/jkms.2010.25.10.1462

Abstract

Transvenous left ventricular (LV) lead implantation is on the increase due to cardiac resynchronization therapy (CRT). However, there has been paucity of data on the prognosis of LV lead. Consecutive 32 patients with LV lead for CRT (n=22) or pacemaker (n=10) were subjected. Serial changes in pacing threshold and impedance along with lead-related complications were evaluated. Over 2 yr follow-up, there was no significant change in relative threshold voltage to the initial value (100%, 110%, 89.6%, and 79.6% at baseline, 1, 6, and 24 months respectively, P=0.62) as well as lead impedance (816+/-272, 650+/-178, 647+/-191, and 590+/-185 ohm at baseline, 1, 6, and 24 months respectively, P=0.80). The threshold change was not affected by lead position, lead polarity, and indication of lead implantation. The cumulative rates of lead revision were 6.3% (n=2) and 9.4% (n=3) in 6 month and 2 yr follow-up, respectively. One case of phrenic nerve capture at left lateral decubitus position was detected 1 month after the implantation. However, there were no serious complications over 2 yr period. In conclusion, transvenous LV lead implantation showed favorable long-term prognosis. Pacing parameters remained stable without significant changes over 2 yr follow-up.

Keyword

Pacemaker; Cardiac vein; Cardiac Resynchronization Therapy; Tricuspid Valve Replacement

MeSH Terms

Adult
Aged
Analysis of Variance
Cardiac Electrophysiology
Cardiac Resynchronization Therapy
*Cardiac Resynchronization Therapy Devices
Female
Follow-Up Studies
*Heart Ventricles
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Ventricular Dysfunction, Left/therapy

Figure

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  Fig. 1 Long-term stability of a left ventricular lead implanted in lateral cardiac veins. LV lead implantation was performed due to both complete atrioventricular block and mechanical tricuspid valve (A, B). The lead remained stable without dislodgement for 42 months (C). mAV, mechanical aortic valve; mMV, mechanical mitral valve; mTV, mechanical tricuspid valve.

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  Fig. 2 Pacing parameters remain stable without significant changes over 2 yr follow-up. There was no significant change in relative threshold voltage to the initial value as well as lead impedance over 2 yr follow-up. *Relative threshold (%)=follow-up voltage/initial voltage×100.

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  Fig. 3 Serial changes in LV pacing threshold and impedance in various subgroups. Long-term stabilities in threshold voltage and lead impedance are still maintained in various subgroups divided depending on lead position, lead polarity, and indication of lead implantation.

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