Comparison of two suturing techniques in terms of lead stabilizing efficiency in acute and chronic terms.

Abstract

Background and aims: Cardiac implantable electronic devices (CIED) are frequently used in the treatment of arrhythmias. Maintenance of lead position is a key element for proper functioning of the CIEDs. There are two suturing techniques that are commonly used to anchor the leads to pectoral muscle (simple knot and anchor knot techniques). While there is one in vitro study comparing lead stabilizing efficacy of these two techniques, there is no in vivo study in the literature. In this in vivo study, the efficacy of lead stabilization between these two techniques was compared.

Methods: Twenty rabbits were included in this study, and they were divided into two equal groups. The anchor knot technique was used in one group, whereas the simple knot technique was used in the other group. The rabbits were followed up for 2 weeks and 4 weeks (acute term and chronic term, respectively). At the end of the acute term, the leads were evaluated for spontaneous dislocation and resistance to at least 10 N of traction force. Whether the leads maintained their position in the sleeve was evaluated by measurement. At the end of 4 weeks, in addition to aforementioned criteria, whether necrosis had occurred was evaluated on pectoral muscle biopsy specimens that included the area where suture was taken. Additionally, the two suturing techniques were also compared for procedural time on the last two rabbits of each group.

Results: Seven and nine rabbits were evaluated for outcomes throughout acute and chronic terms, respectively. Four rabbits died during follow-up, two of which due to anesthetic complications. No lead- or suture-related complications were observed at postmortem examinations of these rabbits. All leads stabilized by using the anchor knot technique maintained their position in the sleeve and were resistant to at least 10 N of traction force in acute and chronic terms. The leads stabilized by the simple knot technique (three rabbits) maintained their position in the acute term, two of them were dislocated under traction and only one of them was found to be partially resistant to at least 10 N of traction force. 0.5 cm of dislocation was observed between that lead and its sleeve after applying traction. Only two leads (50%) stabilized by using the simple knot technique in chronic term remained their position. Lead and sleeve dislocated together in one subject, while the other lead was found separately dislocated from its sleeve. One of the two other leads was resistant to at least 10 N of traction force and that lead remained in stable in sleeve. Muscle biopsy specimens of eight rabbits were evaluated for necrosis. Two of the three samples were found to have necrosis in the simple knot technique group; however, none of the five rabbits in the anchor knot group had necrosis. The time required for the complete stabilization process in the last two rabbits of each suturing technique group was 215 s and 313.5 s on average for simple knot and anchor knot techniques, respectively.

Conclusion: The anchor knot technique provided more effective mechanical stabilization compared to the simple knot technique in acute and chronic terms. The simple knot technique was found to be associated with an increased risk of necrosis in chronic term. Applying the simple knot technique was faster than the anchor knot technique by only 98.5 s on average. Nevertheless, this advantage of the simple knot technique was not considered to be adequately significant when compared to lead stabilization efficiency of the anchor knot technique.