Improved success rate of cardiac resynchronization therapy implant by employing an active fixation coronary sinus lead

Cardiac resynchronization therapy (CRT) is the standard treatment for heart failure with severe reduced left ventricular (LV) function and wide QRS complex. Coronary sinus (CS) lead implantation is challenging and accompanied by substantial dislocation rates. We evaluated the usage of an active fixation LV lead (Attain Starfix™, Medtronic, MN, USA) with deployable lobes in challenging lead positions.

Between September 2006 and August 2009, 678 CRT devices were implanted. In 82 patients (12%) (59 male, 70 ± 10 years, 39 ICM, 41 DCM, 2 valvular CM, LVEF 28 ± 9%, NYHA 3.0 ± 0.4, QRS 169 ± 29 ms), the Attain Starfix active fixation lead was used. The main reason was intra-operative dislodgement of one ( n = 47) or two ( n = 5) passive fixation leads during implantation or revision procedure ( n = 30). Active fixation lead implantation was overall successful with 90% ( n = 74). Anatomical peculiarity was mostly an optimal lead position in otherwise unstable proximal parts of the target vein or a circumscripted areal of optimal threshold without phrenic nerve stimulation. At median follow-up of 99 days the threshold remained stable (1.2 ± 0.8 vs. 1.0 ± 0.5 V at 0.5 ms). Revisions due to instability in ectatic vein ( n = 1) after 12 months and extractions ( n = 2) because of device perforation/infection after 6/15 months were performed without complication.

The Attain Starfix active fixation lead proved to be an important option in anatomically challenging, otherwise unstable positions often located in the proximal part of the target vein. Lead revisions or extractions as late as 15 months after implantation were feasible.