T. Kleemann (Ludwigshafen am Rhein)¹, K. Kouraki (Ludwigshafen am Rhein)¹, M. Strauß (Ludwigshafen am Rhein)¹, A.-R. Wenz (Ludwigshafen am Rhein)¹, A. E. Öztürk (Ludwigshafen am Rhein)¹, U. Weiße (Ludwigshafen)², C. Werling (Ludwigshafen)², F.-U. Sack (Ludwigshafen)², R. Zahn (Ludwigshafen am Rhein)^1
1Klinikum der Stadt Ludwigshafen gGmbH Medizinische Klinik B Ludwigshafen am Rhein, Deutschland; ²Klinikum der Stadt Ludwigshafen gGmbH Herzchirurgie Ludwigshafen, Deutschland

Introduction: Defibrillation lead failure is a typical long-term complication of implantable cardioverter defibrillator (ICD) therapy. ICD shock leads which are inserted by puncturing the subclavian vein, are susceptible to lead failure. Alternative transvenous accesses are the cephalic cutdown or the axillary venous access.
The aim of the study was to assess the effect of different insertion techniques on the rate of defects in transvenous defibrillation leads during long-term follow-up. Methods: A total of 1440 consecutive ICD patients from a prospective single-centre ICD-registry who underwent first ICD implantation between 2008 and 9/2023 were analyzed. Implantation of ICD lead via subclavian puncture was performed from 2008 to 2023, via cephalic access from 2015 to 2020 and via an axillary venous access since 2018. All patients received an ICD lead insulated with silicone-polyurethane.
Results: Baseline characteristics were similar in all groups in terms of age, gender and EF (Table 1). The estimated lead survival rate after 5 years was 96% in the axillary group, 94% in the cephalic group and 89% in the subclavian group (Figure 1).
Conclusion: The rate of defects in ICD leads implanted via axillary venous access was similar to those implanted by cephalic access, whereas insertion via subclavian puncture was associated with a higher ICD lead defect during long-term follow-up.

 

Table 1. Clinical characteristics of patients at time of ICD implantation

 

	Axillary access (n = 246)	Cephalic access  (n = 121)	Subclavian access  (n = 788)	p-value
Age (mean, years)	64 + 14	62 + 14	64 + 11	n.s.
Female	19%	19%	20%	n.s.
EF < 30%	79%	78%	76%	n.s.
Diabetes	31%	31%	32%	n.s.
Atrial fibrillation	41%	33%	35%	n.s.
Renal failure	35%	22%	24%	< 0.001
Ischemic disease	58%	58%	54%	n.s.
Primary prophylaxis	65%	65%	75%	0.001
Implanted ICD -       Single- chamber -        Dual- chamber -        CRT	10% 54% 36%	11% 56% 33%	29% 37% 34%	< 0.001
Silicone-polyurethane insulated ICD lead	100%	100%	100%	n.s.

 

 

Figure 1: Kaplan‐Meier curves of event-free lead function