Lead age as a predictor for failure in pediatrics and congenital heart disease

Background: Pediatric and congenital heart disease (CHD) patients have a high rate of transvenous (TV) lead failure. Objective: To determine whether TV lead age can aid risk assessment for lead failure to guide the decision of whether a lead should be replaced or reused at the time of a generator change. Methods: Retrospective cohort study of patients <21 years old undergoing TV device implant from 2000 to 2014 at our institution. Patient, device, and lead variables were collected. Leads were compared in groups based on how many generator changes were completed. Results: A total of 393 leads in 257 patients met inclusion criteria, 60 leads failed (15%). Failed leads were more likely to have not yet undergone generator change (p =.048). CHD (p =.045), Tendril lead type (p =.02) and silicone insulation (p =.02) were associated with failure. In multivariate analysis, younger leads (p =.022), number of generator changes (p =.003), CHD (p =.005) and silicone insulation (p =.004) remained significant while Tendril lead type did not (p =.052). Survival curves show an early decline around 4 years. Conclusions: Lead failure rate in pediatric and CHD patients is high. Leads that have not yet undergone a generator change were more likely to fail in this cohort. The strategy of serial replacement based on lead age needs further research to justify in this population.