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

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.