Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive disease characterized by replacement of normal myocardium by fibrofatty tissue. The right ventricular (RV) apex is the typical target for implantable cardioverter-defibrillator (ICD) lead placement, raising concerns for suboptimal lead performance in medium- to long-term follow-up.



The purpose of this study was to determine whether placement of ICD leads at the RV apex was associated with performance deterioration of medium-term leads in ARVC patients compared to non-ARVC patients.



In this multicenter, retrospective, case-control study, ICD lead performance measures of R-wave, impedance, and pacing thresholds were compared at baseline and between 1-year and 5-year postimplantation follow-up using mixed-effect models adjusted for age and sex.



One hundred one ARVC patients (49 women, age 50.6 ± 14.5 years) were compared to 56 control patients (37 women, age 48.2 ± 14.2 years). The mean difference in R wave between years 1 and 2 was -0.85 mV (P = .16) compared to a mean difference at years 5 and 6 of -1.85 mV (P = .02). There was no difference in impedance or pacing threshold or in lead lifetime between the 2 groups over 6-year follow-up (5.91 ± 3.89 years vs 5.48 ± 3.70 years, P = .239).



In ARVC patients with ICD leads implanted in the RV apex, ventricular sensing deteriorates significantly during medium-term follow-up. Septal RV lead placement should be explored as the first choice at implantation.
University of British Columbia, Vancouver, British Columbia, Canada.
Adam R M
AR
Herman
QEII Health Sciences Center, Halifax, Nova Scotia, Canada.
Martin
M
Gardner
University of British Columbia, Vancouver, British Columbia, Canada.
Christian
C
Steinberg
University of British Columbia, Vancouver, British Columbia, Canada.
John A
JA
Yeung-Lai-Wah
Population Health Research Institute, Hamilton, Ontario, Canada.
Jeff S
JS
Healey
Western University, London, Ontario, Canada.
Peter
P
Leong-Sit
University of British Columbia, Vancouver, British Columbia, Canada.
Andrew D
AD
Krahn
University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: sc2009@mail.ubc.ca.
Santabhanu
S
Chakrabarti
D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002170:Canada; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004562:Electrocardiography / Q000379:methods; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006346:Heart Septum / Q000473:pathology / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies
Cardiomyopathy; Genetics; Implantation; Lead performance; Sensing; Ventricular tachycardia