An active fixation quadripolar left ventricular lead for cardiac resynchronization therapy with reduced postoperative complication rates

Abstract

Background: The rate of left ventricular (LV) lead displacement after cardiac resynchronization therapy (CRT) remains high despite improvements in lead technology. In 2017, a novel quadripolar lead with active fixation technology became available in the UK.Methods: This was a retrospective, observational study analyzing device complications in 476 consecutive patients undergoing successful first-time implantation of a CRT device at a tertiary center from 2017 to 2020.Results: Both active (n = 135) and passive fixation (n = 341) quadripolar leads had similar success rates for implantation (99.3% vs. 98.8%, p = 1.00), although the pacing threshold (0.89 [0.60-1.25] vs. 1.00 [0.70-1.60] V, p = .01) and lead impedance (632 [552-794] vs. 730 [636-862] Ohms, p < .0001) were significantly lower for the active fixation lead. Patients receiving an active fixation lead had a reduced incidence of lead displacement at 6 months (0.74% vs. 4.69%, p = .036). There was no significant difference in the rate of right atrial (RA) and right ventricular (RV) lead displacement between the two groups (RA: 1.48% vs. 1.17%, p = .68; RV: 2.22% vs.1.76%, p = .72). Reprogramming the LV lead after displacement was unsuccessful in most cases (successful reprogramming: Active fix = 0/1, Passive fix = 1/16) therefore nearly all patients required a repeat procedure. As a result, the rate of intervention

Cardiac resynchronization using fusion pacing during exercise

“…CRT programming was optimized via the Oxford method as previously reported 20 . In brief, Q‐LV was first tested on each pole, with the pole with the longest Q‐LV used for all subsequent testing, unless there was phrenic nerve stimulation near the threshold, in which case next‐best Q‐LVs were used sequentially instead.…”

“…CRT programming was optimized via the Oxford method as previously reported. 20 In brief, Q-LV was first tested on each pole, with the pole with the longest Q-LV used for all subsequent testing, unless there was phrenic nerve stimulation near the threshold, in which case next-best Q-LVs were used sequentially instead. AVDs were set to 120/120 ms, as this has previously been shown to be noninferior to a fusion-based AV optimization algorithm at rest in the SmartAV study.…”

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“…By using the side helix, which is a unique feature of ASQ leads, the stability of the basal CS, maximized by the vein diameter of the CS, is increased. ASQ leads also make LV pacing via a short and small CS branch possible [6]. Inamura, et al reported on a new implantation technique that facilitates insertion of ASQ leads into bent CS branches, a difficult maneuver to achieve with conventional leads, while simultaneously reducing the LV pacing threshold and avoiding phrenic nerve stimulation [7].…”

Conduction System Pacing: Have We Finally Found the Holy Grail of Physiological Pacing?

“… 8 BiVP has been considerably simplified by the advent of guiding catheters which have facilitated canulation of the coronary sinus and by quadripolar leads, 9 as well as with active fixation, which have reduced dislodgment rates and requirement for re-i ntervention. 10 Successful lead implantation is approximately 98% with current tools, and failures mainly being attributed to lack of suitable coronary sinus tributaries. 11 Nevertheless, approximately 80% of patients have the coronary sinus lead placed in a lateral or postero-l ateral position, which are the typically targeted tributaries.…”