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Multicenter Study
. 2020 Nov;31(11):2948-2953.
doi: 10.1111/jce.14694. Epub 2020 Aug 5.

UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads

Dimitrios Gerontitis  1 , Ihab Diab  2 , Anthony W C Chow  3 , Ross J Hunter  3 , Francisco Leyva  4 , Andrew J Turley  5 , Ian Williams  6 , Waqas Ullah  1 ; other members of the Attain Stability Study Group/Consortium
Affiliations
Multicenter Study

UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads

Dimitrios Gerontitis et al. J Cardiovasc Electrophysiol. 2020 Nov.

Abstract

Background: A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads.

Methods: A retrospective study involving six major UK cardiac centers. Patients who received active fixation leads were compared with passive fixation lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macrodisplacement/microdisplacement, defined as displacements requiring repositioning procedures, an increase in threshold ≥0.5 V or pulse width ≥0.5 ms, or a change in pacing polarity).

Results: A total of 761 patients were included (253 AS leads and 508 passive fixation leads), of which 736 had follow-up data. The primary endpoint rate was 31% (75/241) in the active and 43% (214/495) in the passive group (p = .002). Six patients (2.5%) in the active group and 14 patients (2.8%) in the passive group required CS lead repositioning procedures (p = 0.981). On multivariable analysis, active leads were associated with a reduction in lead displacements, odds ratio 0.66 (95% confidence interval: 0.46-0.95), p = .024. There were differences in favor of passive leads in procedure duration, 120 (96-149) versus 127 (105-155) min (p = .008), and fluoroscopy time, 17 (11-26) versus 18.5 (13-27) min (p = .0022). The median follow-up duration was similar (active vs. passive): 31 (17-47) versus 34 (16-71) weeks, (p = .052).

Conclusion: AS CS leads had improved electromechanical stability compared with passive fixation leads, with only minimal increases in implant procedure and fluoroscopy times.

Keywords: active fixation; cardiac resynchronization; coronary sinus lead; lead displacement.

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References

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