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Cardiac Rhythm Management
23 Long term lead survival in adult congenital heart disease patients: a retrospective analysis using clinical correspondence data mining
  1. Ashley Stokes1,
  2. Ozhin Brigante1,
  3. Kelly Rohan1,
  4. Guy Kendall1,
  5. Mehul Patel1,
  6. Bawan Hama1,
  7. Amaran Gill1,
  8. Tasnime Yearoo1,
  9. James Carmichael1,
  10. Raveenjot Nagra1,
  11. Heiko Schneider2,
  12. Vaikom Mahadevan2,
  13. Amir Zaidi2,
  14. Arjamand Shauq2,
  15. Andreas Hoschtitzky2,
  16. Petra Jenkins2,
  17. Jaspal Dua2,
  18. Sam Muhyaldeen2,
  19. Ashish Shah2,
  20. Graeme Kirkwood3
  1. 1University of Manchester
  2. 2CMFT
  3. 3Liverpool Heart and Chest Hospital

Abstract

Background Advances in clinical management have improved life expectancy in the ACHD population; as a result, implantable cardiac devices remain in situ for longer periods than ever before. These patients pose unique challenges, including; young age at implant, multiple device procedures during their lifetime, complex venous and cardiac anatomy, and co-morbidities which may predispose to infection. In the non-ACHD population, there is useful long-term research which helps to guide clinical decision-making; however, small numbers and incomplete outcome data has lead to limited comparability against ACHD patients.

Aims This study aimed to examine 20 years of pacing experience in a large ACHD centre, using novel data-mining techniques to generate comprehensive lead survival data.

Methodology A retrospective analysis was performed of pacing and defibrillator leads implanted between June 1996 and December 2016 in a 173 patient ACHD cohort. Automated text searching algorithms with manual review of over 1 00 000 pieces of clinical correspondence was used to maximise identification of outcomes. Lead-specific complications, non-elective removal and overall lead survival were compared for surgical and transvenous leads in patients with complex and non-complex ACHD anatomy.

Results 340 leads with complete implant and follow-up data were identified of which 53% were in patients with complex ACHD anatomy and 15% were in patients with tricuspid valve abnormalities. Median lead survival time was 13.6 years in transvenous leads and 15.9 years in surgical leads (p=n .s.) Transvenous leads were associated with a higher risk of major infection than were surgically-implanted leads (11.5% vs 0% p<0.05) while surgical leads had a higher rate of pacing failure or lead damage (25.9% vs 8.0% p<0.001). Complication rates were not affected by complex ACHD anatomy or abnormal tricuspid valve function.

Conclusion In this large cohort of patients with ACHD, lead survival appears to be reasonable regardless of whether a transvenous or surgical approach is used. A higher incidence of infection in transvenous leads is offset by a higher electrical failure rate in surgical leads. Further work examining large cohorts is required to determine optimal pacing strategies tailored to patient-specific anatomical challenges.

Figure

Abstract 23 Figure 1 Time to lead failure/non-elective removal

View this table:

Abstract 23 Table 1

  • ACHD
  • Pacing
  • Data Mining

https://doi.org/10.1136/heartjnl-2018-BCS.23

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