Clinical predictors of Fidelis lead failure: report from the Canadian Heart Rhythm Society Device Committee.
BACKGROUND
Approximately 268,000 Fidelis leads were implanted worldwide until distribution was suspended because of a high rate of early failure. Careful analyses of predictors of increased lead failure hazard are required to help direct future lead design and also to inform decision making on lead replacement. We sought to perform a comprehensive analysis of all potential predictors in a multicenter study.


RESULTS
A total of 3169 Sprint Fidelis leads were implanted in 11 centers with a total of 251 failures. Lead failure rates at 3, 4, and 5 years were 5.3%, 10.6%, and 16.8%, respectively. The rate of lead failure continues to accelerate (P<0.001). There were 4 independent predictors of failure: center, sex, access vein, and previous lead failure. Women had a higher hazard of failure (hazard ratio 1.51; 95% confidence interval, 1.14-2.04; P=0.005). Both axillary and subclavian access increased the hazard of failure (P=0.007); hazard ratio for axillary was 1.94, (95% confidence interval, 1.23-3.04) and for subclavian 1.63 (95% confidence interval, 1.08-2.46). Previous lead failure increased the hazard of a subsequent Fidelis failure with a hazard ratio of 3.12 (95% confidence interval, 1.80-5.41; P<0.001).


CONCLUSIONS
The rate of Fidelis failure continues to increase over time, with failures approaching 17% at 5 years. Women, patients with leads inserted via the subclavian or axillary vein, and those with a previous lead fracture were at greatest risk of Fidelis failure. Our data suggest that Fidelis replacement should be strongly considered at the time of generator replacement.
University of Ottawa Heart Institute, ON, Canada. dbirnie@ottawaheart.ca
David H
DH
Birnie
Ratika
R
Parkash
Derek V
DV
Exner
Vidal
V
Essebag
Jeffrey S
JS
Healey
Atul
A
Verma
Benoit
B
Coutu
Teresa
T
Kus
Iqwal
I
Mangat
Felix
F
Ayala-Paredes
Pablo
P
Nery
George
G
Wells
Andrew D
AD
Krahn
D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000453:epidemiology / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D002312:Cardiomyopathy, Hypertrophic / Q000453:epidemiology / Q000628:therapy; D016208:Databases, Factual / Q000706:statistics & numerical data; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000592:standards* / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000628:therapy; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011475:Prosthesis Failure / Q000009:adverse effects* / Q000639:trends; D017678:Sex Distribution; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000628:therapy*