Implanted endocardial lead characteristics and risk of stroke or transient ischemic attack

  • Vaibhav R. Vaidya
  • Christopher V. DeSimone
  • Samuel J. Asirvatham
  • Vishnu M. Chandra
  • Amit Noheria
  • David O. Hodge
  • Joshua P. Slusser
  • Alejandro A. Rabinstein
  • Paul A. Friedman



Patent foramen ovale (PFO) has been recently implicated as a strong predictor of stroke or transient ischemic attack (TIA) in patients with implanted pacemaker or defibrillation leads. Leads in the right heart can form thrombi that embolize to the pulmonary circulation and raise pulmonary pressure. This increases right-to-left shunting through PFO or intrapulmonary shunts and can result in paradoxical embolism. We sought to determine whether certain lead characteristics confer a higher thrombogenic risk resulting in stroke/TIAs in patients either with or without a PFO.


We retrospectively analyzed 5,646 patients (mean age 67.3 ± 16.3 years, 64 % male) who had endocardial device leads implanted in 2000–2010. We performed univariate and multivariate-adjusted proportional hazards models to determine association of lead characteristics with stroke/TIA during follow-up.


On univariate analysis, passively fixated tined leads were associated with more stroke/TIAs (HR 1.77, 95 % CI 1.27, 2.47; p < 0.001), whereas presence of defibrillation coil was associated with fewer stroke/TIAs (HR 0.59, 95 % CI 0.42–0.84; p = 0.003). Number of leads per patient, presence of atrial lead, maximum lead size, tip shape, and type of insulating material were not associated with stoke/TIA. On multivariate analyses adjusting for age, sex, diagnosis of PFO, and prior history of stroke/TIA, the presence of tined leads was associated with stroke/TIA (HR 1.41, 95 % CI 1.00–1.97; p = 0.049). Defibrillation coils were no longer associated with lower stroke/TIA on multivariate analysis.


Most physical characteristics of contemporary leads do not impact rate of stroke/TIA among patients receiving implantable devices. The presence of a PFO is a major risk factor for stroke/TIA in patients with endovascular leads.


Device Leads Stroke TIA Patent foramen ovale 



Confidence interval


Cardiovascular implantable electronic device


Hazard ratio


Patent foramen ovale


Right ventricular systolic pressure


Transient ischemic attack


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Vaibhav R. Vaidya
    • 1
  • Christopher V. DeSimone
    • 5
  • Samuel J. Asirvatham
    • 4
    • 5
  • Vishnu M. Chandra
    • 6
  • Amit Noheria
    • 5
  • David O. Hodge
    • 2
  • Joshua P. Slusser
    • 2
  • Alejandro A. Rabinstein
    • 3
  • Paul A. Friedman
    • 5
  1. 1.Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Department of StatisticsMayo ClinicRochesterUSA
  3. 3.Department of NeurologyMayo ClinicRochesterUSA
  4. 4.Department of Pediatrics and Adolescent MedicineMayo ClinicRochesterUSA
  5. 5.Division of Cardiovascular DiseasesMayo ClinicRochesterUSA
  6. 6.Carnegie Mellon UniversityPittsburghUSA

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