Bipolar active fixation left ventricular lead or quadripolar passive fixation lead? An Italian multicenter experience

Abstract

Aims About one-third of patients receiving cardiac resynchronization therapy (CRT) are not responders, due to either patient selection or technical issues. Left ventricular quadripolar passive fixation leads (QPL) and bipolar active fixation (BAF) leads have been designed to ensure a targeted left ventricular stimulation area, minimizing lead dislodgments and phrenic nerve stimulation (PNS). The aim was to compare real-world safety and efficacy of BAF (Attain Stability, Medtronic Plc.) and QPL (Attain Performa, Medtronic Plc.). Methods We performed a retrospective analysis examining procedural and follow-up data of 261 BAF and 124 QPL (programmed to single-site left ventricular pacing), included in the ClinicalService project from 16 Italian hospitals. Results At median follow-up of 12 months, no difference in left ventricular pacing threshold was recorded between BAF and QPL (1.3 ± 0.9 V @0.4 ms vs. 1.3 ± 1.0 V @0.4 ms; P = 0.749). Total left ventricular lead dislodgement rate was 1.43/100 patient-years in BAF vs. 2.9/100 patient-years in QPL (P = 0.583). However, no dislodgements occurred among BAF after hospital discharge. Events requiring repeated surgery or permanently turning CRT off occurred in 0.8% of BAF, as compared with 4.0% of QPL (P = 0.025). There was no difference between groups in the echo CRT responders’ rate (70% of BAF and 66% of QPL; P = 0.589) or in the annual rate of heart failure hospitalization (P = 0.513). Conclusions BAF resulted in noninferior clinical outcome and CRT responders’ rate in comparison to QPL. Moreover, BAF ensured more precise and stable placement in cardiac veins, with comparable electrical performance and less than 1% patients with unsolved PNS.

UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads

“…Our results are at face value different from those from a previous study comparing bipolar active fixation leads and quadripolar passive leads which found no difference in lead dislodgements 10 . The latter though was based on macrodisplacements and in the current study, we looked at a combination of microdisplacements along with displacements requiring intervention, giving a far more sensitive assessment.…”

“…[7][8][9] A recent retrospective study compared 261 bipolar AS leads with 124 passive quadripolar leads and showed no difference in total displacements between active and passive leads. 10 The lead has also been extracted without incident up to 18 months postimplant. [10][11][12] In view of the novel nonwedged, more proximal active fixation deployment necessitated by the lead, in this study we sought to compare the electromechanical stability of AS with passive fixation CS leads.…”

“…10 The lead has also been extracted without incident up to 18 months postimplant. [10][11][12] In view of the novel nonwedged, more proximal active fixation deployment necessitated by the lead, in this study we sought to compare the electromechanical stability of AS with passive fixation CS leads.…”

“…Early experiences with AS lead implantation show promising results in small single‐arm observational studies 7–9 . A recent retrospective study compared 261 bipolar AS leads with 124 passive quadripolar leads and showed no difference in total displacements between active and passive leads 10 . The lead has also been extracted without incident up to 18 months postimplant 10–12 …”

Performance of an active fixation bipolar left ventricular lead vs passive fixation quadripolar leads in cardiac resynchronization therapy, a randomized trial

“…The optimal long-axis LV lead position is debatable, and the future may show that the optimal long axis position occurs on an individual basis. A nonrandomized multicenter trial that compared active fixation LV leads with quadripolar LV leadsreported noninferior clinical outcomes for the active fixation leads 16.…”