Biomaterial Database

Long-Term Implantable Cardioverter Defibrillator Lead Dysfunction After Left Ventricular Assist Device Implantation. 2025

Tsukasa Oshima, and Kohei Ishibashi, and Kenichiro Yamagata, and Nobuhiko Ueda, and Toshihiro Nakamura, and Satoshi Oka, and Yuichiro Miyazaki, and Akinori Wakamiya, and Kenzaburo Nakajima, and Yu Shimizu, and Takuya Watanabe, and Tsukasa Kamakura, and Mitsuru Wada, and Junichi Ishida, and Yuko Inoue, and Koji Miyamoto, and Eisuke Amiya, and Katsuhito Fujiu, and Masaru Hatano, and Yasumasa Tsukamoto, and Takeshi Aiba, and Satsuki Fukushima, and Norihiko Takeda, and Minoru Ono, and Kengo Kusano

Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

BACKGROUND Implantable cardioverter defibrillator (ICD) lead dysfunction after left ventricular assist device (LVAD) implantation can occur, but only short-term outcomes have been reported. OBJECTIVE We aimed to evaluate the long-term incidence, characteristics, and predictors of persistent ICD lead dysfunction after LVAD implantation. METHODS This was a retrospective multicenter study. All patients with a transvenous ICD lead at the time of LVAD implantation between January 1, 2011, and December 31, 2023, were enrolled. The primary endpoint was lead dysfunction. Risk factors for persistent compared to temporary lead dysfunction using a logistic analysis were determined. RESULTS A total of 170 patients (mean age: 48.0 ± 12.7 years) were analyzed. The median follow-up period was 46.2 (Q1-Q3: 32.3-61.4) months. Lead dysfunction was observed in 124 leads (72.9%), of which 60.4% (N = 75) occurred within a year after LVAD implantation. Of the 124 lead dysfunctions, 84 (67.7%) showed persistent dysfunction and 40 (32.3%) were temporary. Lead dysfunction occurring later than 2.1 months after LVAD implantation was a risk factor for persistent lead dysfunction (area under the curve: 0.673). Multivariable analysis identified lead dysfunction occurring later than 2.1 months after LVAD implantation as an independent risk factor for persistent lead dysfunction (OR: 4.67; 95% CI: 2.05-10.94; P < 0.001). CONCLUSIONS In patients undergoing LVAD implantation, ICD lead dysfunction was observed in 72.9% after a mean follow-up of 46.2 months, of which two-thirds had persistence lead dysfunction. Later occurrence of lead dysfunction (>2 months after implant) may be a risk factor for persistent lead dysfunction.