Abstract 15655: Safety and Efficacy of Subclavian Fibroplasty in Patients With Prior Left Ventricular Lead Implant Failure

Abstract

Introduction: Fibrous subclavian vein obstruction (SVO) is a common primary cause of left ventricular (LV) lead implant failure. Such obstruction might be apparent or unrecognized. Balloon dilation of the aggressive fibrosis that develops in response to chronic leads (fibroplasty) can be employed safely to achieve a successful implant. Hypothesis: To describe the experience of high-volume referral center with balloon dilation of fibrous tissue in patients with prior LV lead implant failure. Methods: We evaluated the role of balloon dilation in 187 patients referred to our institute because of prior LV lead implant failure between June 2017 and November 2019. Results: Of the 187 patients, 35 (19%) had apparent SVO as the primary explanation for implant failure. In 152 (81%), SVO was not recognized as contributing to implant failure. In 32 of 35 with apparent SVO (91.4%), it was possible to cross the obstruction and perform fibroplasty successfully. Three cases (8.6%) failed due to inability to advance a wire through the obstruction, none had existing leads to follow. In 33 of 152 (22%) cases without recognized SVO, fibroplasty of the subclavian was required, in addition to another interventional techniques, for successful implantation. There were no major or minor vascular complications related to fibroplasty. There was no distal embolization and no damage to the existing leads. Conclusions: In the setting of chronic leads, apparent SVO is commonly recognized as a cause of LV lead implant failure. However, 22% of prior LV lead implant failures without obvious obstruction also required fibroplasty (in addition to another interventional techniques) for success. In conclusion, subclavian fibroplasty is essential for successful implantation in patients with prior LV lead implant failure with and without obvious obstruction and can be safely performed by the implanting physician.