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

Dimitrios Gerontitis, Ihab Diab, Anthony WC Chow, Ross J Hunter, Francisco Leyva, Andrew J Turley, Ian Williams, Waqas Ullah

Research output: Contribution to journalArticle

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.
Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
Early online date5 Aug 2020
DOIs
Publication statusE-pub ahead of print - 5 Aug 2020

Keywords

  • active fixation
  • cardiac resynchronization
  • coronary sinus lead
  • lead displacement

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