Background: Cardiac resynchronisation therapy (CRT) confers symptomatic and survival benefits in chronic heart failure with reduced ejection fraction (HFrEF). However, there remains a paucity of data on long-term performance of left ventricular pacing leads, including adverse sequelae.
Methods: Adult patients receiving CRT for HFrEF between 2008 and 2014 were identified retrospectively from an outpatient electronic database at a large tertiary centre (Leeds Teaching Hospitals NHS Trust). Procedural and clinical notes were accessed from individual patient records and used to ascertain post-procedural complications. Acute lead failure was defined as macro-displacement within 24 hours of index procedure. Chronic lead failure was defined as elevated pacing thresholds >24 hours post-procedure due to micro/macro displacement, premature battery depletion, lead failure, lead insulation failure or intractable phrenic nerve stimulation (PNS). Details on device-related infections were also collated.
Results: 280 patients were included, with mean (±SD) age of 74.2 years (±9.0) and 34% (96/280) receiving CRT-D. Median follow-up of patients was 7.6 years (IQR 4-9). Acute lead failure occurred in 0.71% (2/280). Chronic lead failure occurred in 1.79% (5/280). Of these, there were 4 cases of lead macro-displacement, with a median time to dislocation of 45 days, and one case of intractable PNS. Device-related infection occurred in 1.43% (4/280). All cases arose >12 months post-implant, with the identified pathogen Staphylococcus aureus in three instances and Staphylococcus epidermis in one case. All underwent successful full device explant and subsequent re-implantation.
Conclusions: In the context of CRT, left ventricular pacing leads appear to be associated with low incidence of long-term adverse sequelae over prolonged follow-up.