Lead Longevity in Pediatric and Congenital Heart Disease Patients: The Impact of Patient Somatic Growth

Authors

Jeff Hong, Division of Cardiology, Children's National Hospital, Washington, DC, USA; Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: JeffHongMD@gmail.com.
Carolyn B. Ramwell, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Alston R. Lewis, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Vanessa N. Ogueri, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Nak Hyun Choi, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
HebatAllah F. Algebaly, Department of Pediatrics, Cairo University School of Medicine, Cairo, Egypt.
John R. Barber, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Charles I. Berul, Division of Cardiology, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
Elizabeth D. Sherwin, Division of Cardiology, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
Jeffrey P. Moak, Division of Cardiology, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.

Document Type

Journal Article

Publication Date

1-1-2025

Journal

JACC. Clinical electrophysiology

Volume

11

Issue

1

DOI

10.1016/j.jacep.2024.09.029

Keywords

cardiovascular implantable electronic device; defibrillator; lead failure; pacemaker; pediatric cardiology

Abstract

BACKGROUND: Pacemakers and implantable cardioverter-defibrillators in pediatric and congenital heart disease (CHD) patients may be required for decades. In this population, there are sparse data on long-term lead functionality. OBJECTIVES: The aims of this study were to assess pacemaker and defibrillator lead survival in pediatric and CHD patients beyond 10 years after implantation and to identify patient- and lead-related factors associated with earlier lead failure. METHODS: This was a retrospective study reviewing all patients with a pacemaker or defibrillator who received care at a single large children's hospital during a 30-year timespan. The log-rank test and Cox proportional hazards model were used to identify risk factors associated with earlier lead failure. RESULTS: Data were collected from 952 leads in 396 patients. Overall lead survival was 87% at 10 years, 78% at 15 years, and 69% at 20 years. Male sex, younger patient age, greater somatic growth, left ventricular lead location, and epicardial implantation approach were associated with higher likelihood of lead failure (log-rank test P <0.05). On multivariate analysis, the most significant predictor of lead failure was patient somatic growth ≥5 cm/year (HR 3.33; 95% CI: 1.78-6.25). The presence of CHD, lead insulation, and lead manufacturer had no impact on lead longevity. CONCLUSIONS: Greater patient somatic growth is an important predictor of lead failure. Greater somatic growth may account for the observation in this study (and prior studies) that leads in male patients, younger patients, and implanted via epicardial approach were more likely to fail.

APA Citation

Hong, Jeff; Ramwell, Carolyn B.; Lewis, Alston R.; Ogueri, Vanessa N.; Choi, Nak Hyun; Algebaly, HebatAllah F.; Barber, John R.; Berul, Charles I.; Sherwin, Elizabeth D.; and Moak, Jeffrey P., "Lead Longevity in Pediatric and Congenital Heart Disease Patients: The Impact of Patient Somatic Growth" (2025). GW Authored Works. Paper 6475.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6475

Department

Pediatrics