Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Monitoring & Follow-up D-PO05 - Poster Session V (ID 39) Poster

D-PO05-080 - Potential Of Intensive Remote Surveillance To Detect Pacemaker/ICD Lead Dislodgment (ID 1260)

Abstract

Background: Pacing/ICD lead dislodgment may have severe consequences including syncope, inappropriate therapy and even death. Remote monitoring systems may detect dislodgments while only two manufacturers offer specific alerts for sensing amplitude and pacing threshold.
Objective: To assess the potential benefit of intensive remote lead surveillance for detection of lead dislodgment through evaluation of all available alerts and transmitted electrograms.
Methods: From 2013 to 2019, a total of 8551 leads (2643 atrial; 3794 RV, 1352 ICD, 762 LV) were implanted in our center. Cases of lead dislodgment occurring during the first year after implant were collected with circumstances of diagnosis. In-hospital dislodgments and cases of perforation were excluded.
Results: Forty-eight (0.5%) out-of-hospital lead dislodgments occurred (22 atrial; 8 RV, 10 ICD, 8 LV) with a median delay of 30 days [4-280] of which 34 (71%) were remotely monitored. In absence of remote monitoring, 14 lead dislodgments were diagnosed, through symptoms in 5 cases (36%) and by accident through routine evaluation in 9 cases (64%). Under remote monitoring, 34 lead dislodgments were diagnosed, remotely in 15 cases (44%), through symptoms in 5 cases (15%) and routinely in 14 cases (41%). Remote diagnoses were made by lead alerts in 5 cases (33%) by periodic electrograms in 4 cases (26%) and by other alerts (%CRT and AF alerts) in 6 cases (40%).
Conclusion: Remote monitoring of pacemakers/ICDs provides opportunities for detection of lead dislodgment. Alerts for pacing/sensing abnormalities should be encouraged as well as careful inspection of every transmitted EGM.
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