Active versus passive fixation of the quadripolar left ventricular lead in cardiac resynchronization therapy

Background: Heart failure due to cardiovascular disease is a leading cause of death worldwide and significantly impairs quality of life. Cardiac resynchronization therapy (CRT) is an established treatment option for many patients, which includes a right atrial lead, a right ventricular lead and an additional left ventricular lead in the coronary sinus. The current standard is the use of a left ventricular lead with four poles (quadripolar). The aim of this study is to compare passive anchor fixation versus active screw fixation of the left ventricular quadripolar lead.

Methods: 97 patients were included, divided into two cohorts (Medtronic Attain stability quad®, active fixation n = 50, Medtronic Attain performa®, passive fixation n = 47). A retrospective analysis of patient data was performed to compare these two cohorts. Implantation time, fluoroscopy time, radiation dose, pacing threshold, impediance and complication rate were analyzed.

Results: Implantation time (67.5 min vs 98.0 min; p<0.05) and flouroscopy time (10.3 min vs 13.7 min; p<0.05) were significantly lower in the active fixation group.The other parameters analyzed did not show any significant differences the two groups.

Conclusion: This is the first study comparing two currently available implantation techniques of a quadripolar left ventricular lead in cardiac resynchronization therapy. Both techniques showed an adequate and comparable efficacy and safety. Overall our analysis shows a faster implantation and shorter fluoroscopy time using an active fixation quadripolar lead by yielding comparable technical results.