Acute lead dislodgements and in-hospital mortality in patients enrolled in the national cardiovascular data registry implantable cardioverter defibrillator registry.
OBJECTIVE
We sought to describe the incidence of acute lead dislodgements and the consequences of these events in patients enrolled in the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator (ICD) Registry.


BACKGROUND
Lead dislodgements are common adverse events in patients undergoing ICD implants. Little is known regarding who is at risk and the consequences of these events.


METHODS
Patients enrolled between April 2006 and September 2008 were included. Acute lead dislodgement was defined as movement of the lead requiring another procedure for repositioning before discharge.


RESULTS
Acute dislodgement occurred in 2,628 of 226,764 patients. Univariate variables associated with dislodgements included older age, female sex, and patients with atrial fibrillation, chronic lung disease, cerebrovascular disease, nonischemic cardiomyopathy, and lower ejection fractions (all p < 0.002). After multivariate adjustment, factors associated with an increased risk for dislodgement included New York Heart Association functional class IV heart failure, atrial fibrillation/flutter, having a cardiac resynchronization therapy-defibrillator device, and procedures performed by physicians trained under alternative pathways. A teaching/training hospital setting was not a factor (p = 0.64). Acute dislodgements had increased odds for other adverse events including cardiac arrest, cardiac tamponade, device infection, pneumothorax, and in-hospital death even after adjustment for potential confounders (all p < 0.0001).


CONCLUSIONS
Acute lead dislodgements occur more often in patients with more comorbidities and in patients undergoing implants by nonelectrophysiology-trained implanters. These events were strongly associated with increased odds for in-hospital death.
Section of Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. alcheng@jhmi.edu
Alan
A
Cheng
Yongfei
Y
Wang
Jeptha P
JP
Curtis
Paul D
PD
Varosy
D000208:Acute Disease; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012955:Societies, Medical / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology