Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy

BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive disease characterized by replacement of normal myocardium by fibrofatty tissue. The right ventricular (RV) apex is the typical target for implantable cardioverter-defibrillator (ICD) lead placement, raising concerns for suboptimal lead performance in medium- to long-term follow-up. OBJECTIVE The purpose of this study was to determine whether placement of ICD leads at the RV apex was associated with performance deterioration of medium-term leads in ARVC patients compared to non-ARVC patients. METHODS In this multicenter, retrospective, case-control study, ICD lead performance measures of R-wave, impedance, and pacing thresholds were compared at baseline and between 1-year and 5-year postimplantation follow-up using mixed-effect models adjusted for age and sex. RESULTS One hundred one ARVC patients (49 women, age 50.6 +/- 14.5 years) were compared to 56 control patients (37 women, age 48.2 +/- 14.2 years). The mean difference in R wave between years 1 and 2 was -0.85 mV (P = .16) compared to a mean difference at years 5 and 6 of -1.85 mV (P = .02). There was no difference in impedance or pacing threshold or in lead lifetime between the 2 groups over 6-year follow-up (5.91 +/- 3.89 years vs 5.48 +/- 3.70 years, P = .239). CONCLUSION In ARVC patients with ICD leads implanted in the RV apex, ventricular sensing deteriorates significantly during medium term follow-up. Septal RV lead placement should be explored as the first choice at implantation.