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Lead positioning for cardiac resynchronization therapy, a randomized trial comparing an active fixation bipolar left ventricular lead and a passive fixation quadripolar lead

Session Poster session 3

Speaker Havard Keilegavlen

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session
  • FP Number : P1524

Authors : H Keilegavlen (Bergen,NO), T Hovstad (Bergen,NO), S Faerestrand (Bergen,NO)

Authors:
H Keilegavlen1 , T Hovstad1 , S Faerestrand2 , 1Haukeland University Hospital, Department of Heart Disease - Bergen - Norway , 2University of Bergen, Dept. of Clinical Science - Bergen - Norway ,

Citation:

Background:Targeting the left ventricular (LV) lead to a coronary vein located concordant to the LV segment with latest mechanical activation and avoidance of an apical position maximizes the responder rate to cardiac resynchronization therapy (CRT). 

Purpose: To compare a bipolar LV lead with a side helix for active fixation (bipol) and a quadripolar LV lead with passive fixation (quad) concerning the electrical performance and the ability to achieve an optimal and stable position. 

Methods:The bipol has a maximum lead body diameter of 3.9 Fr versus 5.3 Fr. for the quad. Sixty two consecutive patients (pts; mean age 72±11 years; 27% females) scheduled for CRT implantation were randomly assigned to the bipol (n=31) or to the quad (n=31). The LV ejection fraction was 26±6%. The LV lead was targeted to a vein concordant to the LV segment with latest mechanical contraction decided by preoperative radial strain echocardiography. A five segments LV model was used.

Results (table):Initial successful implantation was achieved in 31 pts. (100%) and 30 pts. (97%) in the bipol group and the quad group, respectively.  In 1 pt. an alternative stiffer bipolar LV lead was implanted. In 3 patients LV lead dislodgement occurred, all in the active fixated group.

Conclusions:The target placement was attained with both the bipol and the quad in the majority of pts. At follow up the pacing capture thresholds were low and stable with no significant difference between the two leads. Active fixation did not facilitate a more proximal position to the stimulating electrode.

Active fication lead (n=31) Quadripolar lead (n=30) P-value
Number of veins attempted (n) 1.1±0.52 1.29±0.4 0.26
PCT at implantation (V) 1.09±0.48 0.77±0.25 0.02
PCT at at 6 months follow up (V) 1.16±0.76 1.02±0.74 0.35
PCT at 12 months follow up (V) 1.23±0.75 1.03±0.86 0.46
LV lead impedance at implantation (Ohm) 539±159 414±94 0.00
LV lead implantation time (min) 13.2±11 12.2±12 0.75
Q-LV sense (ms) 155±30 154±35 0.88
Lead in concordant or adjacent segment (n%)) 27 (87) 25 (83) 0.69
Lead in a remote segment (n%)) 4(13) 5(17) 0.69
Distance from CS to active electrode as percentage of distance CS to apex (%) 36±11 33±12 0.26
PCT=pacing capture threshold at 0.4ms puls duration. LV=left ventricular. Q-LV sense=conduction time from start of Q in the electrocardiogram to the sensed R-wave electrogram from the left ventricular (LV) lead. CS= coronary sinus

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