Survival of transvenous ICD leads in young patients

Background: In adults, transvenous implantable cardioverter defibrillator (ICD) lead failure rates are significant, and their occurrence increases with time from implant. There are limited data in children. The goal of this study was to assess lead survival in young patients undergoing ICD implantation at a single center. Methods: Records of patients under 21 years old with transvenous ICD leads implanted at our center from June 1997 to August 2007 were retrospectively reviewed. Age, weight, height, diagnosis, lead and generator model, venous access technique, generator position, pacing thresholds, lead impedance, and R wave size were recorded. "Lead failure" was defined as any lead problem requiring surgical intervention to restore proper function to the ICD system. Results: Seventy-one transvenous leads were included (70 patients). Average age at implant was 14.8 years (range 5.7-19.5). All the devices were implanted by a single operator (HMS). Venous access was obtained via cephalic cutdown in 66/71. Mean follow-up time was 2.8 years (range 0.2-7.8 years, median 2.3 years). There were no infections requiring explantation. There were four lead failures. Three were lead fractures, occurring 12, 13, and 19 months after implant. The fourth lead failed when an arrhythmia was not appropriately detected, and a second dedicated rate-sensing lead was thus implanted. Univariate analysis did not identify any variable to be a significant predictor of lead failure. Kaplan-Meier survival analysis demonstrated 5-year lead survival at 89.6%. Conclusions: ICD lead survival in children, when performed by an experienced operator, is similar to that found in adults.