Key result
Active fixation quadripolar LV leads linked to ~84% lower 6-month displacement risk versus passive leads.
Why the study?
The rate of left ventricular lead displacement after cardiac resynchronization therapy remains high despite improvements in lead technology.
Does an active fixation quadripolar left ventricular lead reduce lead displacement at 6 months in patients undergoing first-time CRT implantation compared to passive fixation leads?
Observational (n=476)
No
Does an active fixation quadripolar left ventricular lead reduce lead displacement at 6 months in patients undergoing first-time CRT implantation compared to passive fixation leads?
Absolute Event Rate: 0.74% vs 4.69%
p-value: p=0.036
The use of an active fixation quadripolar left ventricular lead significantly reduces the incidence of lead displacement and the need for re-intervention at 6 months compared to conventional passive fixation leads in CRT patients.
Active fixation quadripolar leads may reduce displacements in CRT; leaves open routine adoption pending randomized confirmation.
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 within 6 months for lead displacement was significantly lower when patients were implanted with the active fixation lead (0.74% vs. 4.40%, p = .049). CONCLUSION: The novel active fixation lead in our study has a lower incidence of lead displacement and re-intervention compared to conventional quadripolar leads for CRT.
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Robertson et al. (2021) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=476). Active fixation quadripolar left ventricular lead vs. Conventional passive fixation quadripolar left ventricular leads was evaluated on Left ventricular lead displacement at 6 months (p=0.036). The active fixation quadripolar left ventricular lead significantly reduced the incidence of lead displacement at 6 months to 0.74% compared to 4.69% with conventional passive fixation leads.
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