Lead replacement due to non-infectious reasons in patients undergoing traditional cardiac resynchronization therapy in long-term follow-up

Background Traditional cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure. Objective The study aimed to determine the long-term durability of CRT leads, factors predisposing to replacement, and the outcomes of lead replacement in CRT patients. Methods The study population consisted of 1059 consecutive patients with conventional CRT implanted between 2002 and 2019 in a university hospital. Results During the median follow-up of 1661 days (IQR: 815–2792), a total of 324 leads were replaced in 251 patients (23.7%) for non-infectious reasons. Of those who required lead replacement, 126 subjects (50.2%) had the procedure within the first year since CRT implantation. In patients followed over ten years (n=143; 13.5%), 67 subjects (46.8%) had one or more lead replacements. Duration of index CRT procedure and fluoroscopy time were independent predictors for lead replacement in a multivariable analysis (HR 1.03, 95% CI 1.01–1.06, P=0.02 and HR 1.11, 95% CI 1.02–1.15, P=0.01, respectively). Leads that required replacement were left ventricular (11.2%), right ventricular (10.8%), and right atrial (4%), respectively. As compared with no need for re-intervention, lead-related re-do procedures did not influence overall long-term mortality (55.3% vs 51%, P=0.3) nor incidence of device-related infective endocarditis (5.6% vs 4.5%, P=0.82). Conclusions Almost 25% of patients with CRT require lead replacement within 4.5 years due to non-infectious reasons, and half of those need replacement within the first year. In ten years, nearly every second patient requires a lead-related re-do procedure. Lead replacement does not affect long-term all-cause mortality.