Right atrial lead fixation type and lead position are associated with significant variation in complications.
OBJECTIVE
Optimal atrial pacemaker lead position and fixation mechanism have not been determined with regard to effect on complications. We aimed to determine the association between atrial lead-related complications and varying atrial lead tip positions and lead fixation mechanisms.


METHODS
All patients who underwent dual-chamber pacemaker implant between 2004 and 2014 were retrospectively reviewed for atrial lead tip position and fixation type. Lead-related complications were assessed by electronic medical record review. Complication rates were compared at 1 year by chi-square analysis and at 5 years using a Kaplan-Meier analysis.


RESULTS
During the study period, 3451 patients (mean age 73.9, 53.4 % male) underwent dual-chamber pacemaker placement. Active fixation leads were associated with a higher incidence of pericardial effusion (81 (2.9 %) vs. 6 (1.0 %), p = 0.005) and pericardiocentesis (46 (1.6 %) vs. 2 (0.3 %), p = 0.01) at 1 year compared to passive fixation leads. There was no difference in overall complication rates by fixation type (161 (5.7 %) vs. 29 (4.6 %), p = 0.26). Low atrial septal lead tip position was associated with a higher rate of lead dislodgement (10 (15.2 %)) compared to appendage (46 (1.6 %)), free wall (10 (2.1 %)), or high atrial septal (2 (4.7 %)) positions (p < 0.001). This difference was also reflected in a significantly increased need for lead revision and overall complications. A multivariate analysis which included potential confounders confirmed the association of active fixation leads with an increased rate of perforation-related complications (p = 0.03) and septal lead location with increased rates of dislodgement (p < 0.001).


CONCLUSIONS
Active compared to passive lead fixation increases the risk for pericardial effusion requiring pericardiocentesis. There is a clear association between low atrial septal lead position and lead dislodgement requiring lead revision.
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Chance M
CM
Witt
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Charles J
CJ
Lenz
Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Henry H
HH
Shih
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Elisa
E
Ebrille
Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Andrew N
AN
Rosenbaum
Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Htin
H
Aung
Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Martin
M
van Zyl
Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Kevin K
KK
Manocha
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Abhishek J
AJ
Deshmukh
Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
David O
DO
Hodge
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Siva K
SK
Mulpuru
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Yong-Mei
YM
Cha
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Raul E
RE
Espinosa
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Samuel J
SJ
Asirvatham
Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. mcleod.christopher@mayo.edu.
Christopher J
CJ
McLeod
D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D020878:Device Removal / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010490:Pericardial Effusion / Q000453:epidemiology* / Q000601:surgery; D020519:Pericardiocentesis / Q000706:statistics & numerical data; D015995:Prevalence; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome
Complications; Fixation type; Lead position; Pacemaker lead