Could persistency of current of injury forecast successful active-fixation pacing lead implantation?. (1st May 2018)

• Record Type: Journal Article
• Authors: Shali, Shalaimaiti; Su, Yangang; Qin, Shengmei; Ge, Junbo
• Is Part Of: International journal of cardiology. Volume 258(2018)
• Page Start: 121
• Page End: 125
• Publication Date: 2018-05-01
• Subjects: COI current of injury -- RV right ventricular -- RVA RV apex -- RVOT RV outflow tract -- RA Right atrium -- EGM electrogram -- OR odds ratio -- CI confidential interval -- HR hazard ratio -- ROC receiver-operating characteristic -- AUC area under curve -- NYHA New York Heart Association -- LVEF left ventricular ejection fraction -- CKD chronic kidney disease -- BMI body mass index -- SSS sick sinus syndrome -- AVB atrioventricular block -- CIED cardiac implantable electronic device; Current of injury -- Active-fixation lead -- Pacemaker; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.01.005
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Presence of adequate current of injury (COI) was recognized as a sign of favorable pacemaker lead outcome. Little is known regarding the value of its dynamic behavior. We sought to test whether persistency of COI could predict active-fixation pacing lead performance. Methods: COI was monitored up to 10 min after right ventricular (RV) pacing electrode fixation. COI persistency was defined as the percentage of COI magnitude relative to its initial measurement. An unacceptable pacing threshold (≥ 1.0 V in acute evaluation or ≥ 2.0 V over 2-year follow-up) with or without lead dislodgement was considered as lead failure. Results: Lead implantation was attempted for 217 times in 174 patients (age 66.3 ± 7.8 years, 78 female). Acute lead failures occurred 43 times. Independent predictors of acute lead failure were RV enlargement (odds ratio [OR] 1.23, 95% confidential interval [CI] 1.11–2.04, P = 0.033), absence of COI (OR 3.13, 95%CI 2.08–9.09, P = 0.027), and COI persistency at 5 min (OR 0.32, 95%CI 0.20–0.69, P = 0.001) and 10 min (OR 0.41, 95%CI 0.13–0.77, P = 0.001). The optimal cutoffs were COI5 min persistency ≥ 50% (sensitivity 81.4%; specificity 81.9%) and COI10 min persistency ≥ 20% (sensitivity 86%; specificity 88.6%). There were 12 lead failures during 24.0 ± 6.4 months of follow-up. Patients with COI5 min persistency ≥ 50% had higher event-free survival compared to those with COI5 min persistency < 50% (hazard ratio 3.54, 95% CI 1.04–12.06, P = 0.043). Conclusions: COI persistency appears to be a valuable indicator for both acute and long-term outcome of active-fixation pacemaker leads. A precipitous decline in COI may require more attention to make sure of the lead performance. Highlights: Determining the quality of lead fixation based on the initial measurements of current of injury (COI) may hold a risk of overestimation. It appears to be worthwhile to monitor dynamic COI behavior after lead fixation for at least 5 min. COI persistency ≥50% at 5 min might be recommended as a useful indicator of proper lead positioning. Repositioning might be considered once a quick recovery of COI occurs.