Abstract
Background
A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads.
Methods
A retrospective study involving six major UK cardiac centers. Patients who received active fixation leads were compared with passive fixation lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macrodisplacement/microdisplacement, defined as displacements requiring repositioning procedures, an increase in threshold ≥0.5 V or pulse width ≥0.5 ms, or a change in pacing polarity).
Results
A total of 761 patients were included (253 AS leads and 508 passive fixation leads), of which 736 had follow‐up data. The primary endpoint rate was 31% (75/241) in the active and 43% (214/495) in the passive group (p = .002). Six patients (2.5%) in the active group and 14 patients (2.8%) in the passive group required CS lead repositioning procedures (p = 0.981). On multivariable analysis, active leads were associated with a reduction in lead displacements, odds ratio 0.66 (95% confidence interval: 0.46–0.95), p = .024. There were differences in favor of passive leads in procedure duration, 120 (96–149) versus 127 (105–155) min (p = .008), and fluoroscopy time, 17 (11–26) versus 18.5 (13–27) min (p = .0022). The median follow‐up duration was similar (active vs. passive): 31 (17–47) versus 34 (16–71) weeks, (p = .052).
Conclusion
AS CS leads had improved electromechanical stability compared with passive fixation leads, with only minimal increases in implant procedure and fluoroscopy times.
A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads.
Methods
A retrospective study involving six major UK cardiac centers. Patients who received active fixation leads were compared with passive fixation lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macrodisplacement/microdisplacement, defined as displacements requiring repositioning procedures, an increase in threshold ≥0.5 V or pulse width ≥0.5 ms, or a change in pacing polarity).
Results
A total of 761 patients were included (253 AS leads and 508 passive fixation leads), of which 736 had follow‐up data. The primary endpoint rate was 31% (75/241) in the active and 43% (214/495) in the passive group (p = .002). Six patients (2.5%) in the active group and 14 patients (2.8%) in the passive group required CS lead repositioning procedures (p = 0.981). On multivariable analysis, active leads were associated with a reduction in lead displacements, odds ratio 0.66 (95% confidence interval: 0.46–0.95), p = .024. There were differences in favor of passive leads in procedure duration, 120 (96–149) versus 127 (105–155) min (p = .008), and fluoroscopy time, 17 (11–26) versus 18.5 (13–27) min (p = .0022). The median follow‐up duration was similar (active vs. passive): 31 (17–47) versus 34 (16–71) weeks, (p = .052).
Conclusion
AS CS leads had improved electromechanical stability compared with passive fixation leads, with only minimal increases in implant procedure and fluoroscopy times.
| Original language | English |
|---|---|
| Pages (from-to) | 2948-2953 |
| Number of pages | 6 |
| Journal | Journal of Cardiovascular Electrophysiology |
| Volume | 31 |
| Issue number | 11 |
| Early online date | 5 Aug 2020 |
| DOIs | |
| Publication status | Published - 1 Nov 2020 |
Keywords
- active fixation
- cardiac resynchronization
- coronary sinus lead
- lead displacement