Key result
Straight screw-in atrial leads had similar complication rates to passive and active J-shaped leads (0.6% vs 0.1% and 1.6%) but fewer dislodgements than passive leads (0 vs 16; P=0.04).
Why the study?
Does a straight screw-in atrial lead improve stability and safety compared to J-shaped leads in patients undergoing pacemaker/ICD implantation?
Cohort (n=915)
Does a straight screw-in atrial lead improve stability and safety compared to J-shaped leads in patients undergoing pacemaker/ICD implantation?
Absolute Event Rate: 0.6% vs 0.1%
p-value: p=0.3
Straight screw-in atrial leads offer better stability than passive-fixation J-shaped leads with a similar safety profile up to 3 months postimplantation.
May support straight screw-in leads for stability; leaves open randomized confirmation before changing practice.
BACKGROUND AND OBJECTIVES: The reliability of active-fixation atrial leads has been compared with that of passive-fixation leads; comparisons have also been made between straight and J-shaped screw-in lead systems. However, few data are available on procedural and short-term safety. This retrospective study compared the procedural safety of non-pre-shaped screw-in leads with that of passive- and active-fixation J-shaped leads. PATIENTS AND METHODS: From January 2004 to January 2010, 1,464 patients underwent new pacemaker/implantable cardioverter-defibrillator implantation. Of these, 915 (study population) received a passive- or active-fixation pre-J-shaped lead, or a straight screw-in atrial lead; the remaining 549 patients, who received only a ventricular lead, were excluded. The three study groups were: Group S-FIX (165 patients, 18%), receiving a straight screw-in atrial lead (postshaped in the right appendage); Group J-PASS (690 patients, 75.4%), receiving a passive-fixation J-shaped atrial lead; and Group J-FIX (60 patients, 6.6%), receiving an active-fixation screw-in J-shaped atrial lead. Procedural and short-term complication rates were analyzed up to 3 months postimplantation. RESULTS: One complication occurred in each group (S-FIX 0.6% vs J-PASS 0.1% vs J-FIX 1.6%, P = 0.3, 0.1, and 0.4, respectively, for each comparison). The rate of atrial lead dislodgement was higher in Group J-PASS than in S-FIX but not J-FIX (Group S-FIX 0 vs Group J-PASS 16 vs Group J-FIX 1 dislodgements; P = 0.04 and 0.7, respectively). CONCLUSION: Straight screw-in atrial leads, "J-post shaped" in the right appendage, offer better stability than passive-fixation J-shaped leads and display a similarly acceptable safety profile compared with both the J-shaped systems.
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Zoppo et al. (2011) conducted a cohort in Pacemaker or implantable cardioverter-defibrillator implantation (n=915). Straight screw-in atrial leads vs. Passive-fixation and active-fixation J-shaped atrial leads was evaluated on Procedural and short-term complication rates (p=0.3). Straight screw-in atrial leads had similar complication rates to passive and active J-shaped leads (0.6% vs 0.1% and 1.6%) but fewer dislodgements than passive leads (0 vs 16; P=0.04).
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