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Cephalic access for multi-lead defibrillator therapy is not associated with premature high voltage lead failure
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  • Zaki Akhtar,
  • Idris Harding,
  • Ahmed El Batran,
  • Hanney Gonna,
  • Nilanka Mannakkara ,
  • Lisa Leung,
  • Zia Zuberi,
  • Abhay Bajpai,
  • Simon Pearse,
  • Andrew Cox,
  • Anthony Li,
  • Fadi Jourha,
  • Oswaldo Valencia,
  • Zhong Chen,
  • Manav Sohal,
  • Ian Beeton,
  • Mark Gallagher
Zaki Akhtar
St George's University Hospitals NHS Foundation Trust
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Idris Harding
St George's University Hospitals NHS Foundation Trust
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Ahmed El Batran
St George's University Hospitals NHS Foundation Trust
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Hanney Gonna
St George's Hospital
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Nilanka Mannakkara
St George's University Hospitals NHS Foundation Trust
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Lisa Leung
St George's University Hospitals NHS Foundation Trust
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Zia Zuberi
University of London St George's Molecular and Clinical Sciences Research Institute
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Abhay Bajpai
University of London St George's Molecular and Clinical Sciences Research Institute
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Simon Pearse
St George's University Hospitals NHS Foundation Trust
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Andrew Cox
Frimley Park NHS foundation trust, UK
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Anthony Li
St George's University Hospitals NHS Foundation Trust
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Fadi Jourha
St George's University Hospitals NHS Foundation Trust
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Oswaldo Valencia
St George's University Hospitals NHS Foundation Trust
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Zhong Chen
Guys and St Thomas NHS Trust
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Manav Sohal
St. George's University Hospitals NHS Foundation Trust
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Ian Beeton
St Peter's Hospital, Chertsey
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Mark Gallagher
St George's Hospital
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Abstract

Background: Cardiac resynchronisation therapy-defibrillator (CRT-D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter defibrillator (ICD) lead failure in multi-lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT-D implantation via the cephalic and ICD lead failure. Methods: Data was collected from three CRT-D implanting centres between October 2008 – September 2017. In total 631 patients were included. Patient and lead characteristics with ICD lead failure were recorded. Comparison of ‘cephalic’ (ICD lead via cephalic) vs ‘non-cephalic’ (ICD lead via non-cephalic route) cohorts was performed. Kaplan-Meier survival and a Cox-regression analysis were applied to assess variables associated with lead failure. Results: The cephalic and non-cephalic cohorts were equally male (82.2% vs 78.3%, p=0.28), similar in age (69.7±11.5 vs 68.7 ± 11.9, p=0.33) and body mass index (BMI) (27.7±5.1 vs 27.1±5.7, p=0.33). Most ICD leads were implanted via the cephalic vein (73.7%) and patients had a median of 2.8 leads implanted via this route. The rate of ICD lead failure was low and similar between both groups (0.4%/year vs 0.14%/year, p=0.34). Female gender was more common in the lead failure cohort than non-failure (50% vs 18.2%, respectively, p=0.01) as was hypertension (90% vs 54%, respectively, p=0.03). On multivariate Cox regression, female sex (p=0.007), hypertension (p=0.041) and BMI (p=0.042) were significantly associated with ICD lead failure. Conclusion: CRT-D implantation via the cephalic route is not associated with premature ICD lead failure. Female gender, BMI and hypertension correlate with lead failure.

Peer review status:ACCEPTED

07 Oct 2020Submitted to Journal of Cardiovascular Electrophysiology
08 Oct 2020Submission Checks Completed
08 Oct 2020Assigned to Editor
11 Oct 2020Reviewer(s) Assigned
03 Nov 2020Review(s) Completed, Editorial Evaluation Pending
05 Nov 2020Editorial Decision: Revise Minor
16 Nov 20201st Revision Received
24 Nov 2020Assigned to Editor
24 Nov 2020Submission Checks Completed
24 Nov 2020Reviewer(s) Assigned
16 Dec 2020Review(s) Completed, Editorial Evaluation Pending
26 Dec 2020Editorial Decision: Revise Minor
14 Jan 20212nd Revision Received
16 Jan 2021Submission Checks Completed
16 Jan 2021Assigned to Editor
16 Jan 2021Reviewer(s) Assigned
26 Jan 2021Review(s) Completed, Editorial Evaluation Pending
01 Feb 2021Editorial Decision: Accept