Competing risks analysis: A new approach to model lead failures

Introduction: Pacing lead failure is a major concern to patients, physicians and lead design engineers. Lead failure mechanisms include problems with threshold, sensing and lead fracture. For the purposes of designing or selecting better leads, these events should not be treated as identical. In general, when a lead is removed from service due to one of these failures, it is no longer considered at risk for an alternate failure mechanism. Competing risks analysis is a statistical technique that distinguishes different types of events to estimate separate hazard functions for each event type. We sought to compare cause-specific hazard for lead failure in a competing risks analysis, using a population of children with a single epicardial lead type as a model for lead failure analysis.