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. 2020 Nov 8;37(1):212-218.
doi: 10.1002/joa3.12450. eCollection 2021 Feb.

Performance of an active fixation bipolar left ventricular lead vs passive fixation quadripolar leads in cardiac resynchronization therapy, a randomized trial

Havard Keilegavlen  1   2 , Peter Schuster  1   2 , Thomas Hovstad  1 , Svein Faerestrand  1   2
Affiliations

Performance of an active fixation bipolar left ventricular lead vs passive fixation quadripolar leads in cardiac resynchronization therapy, a randomized trial

Havard Keilegavlen et al. J Arrhythm. .

Abstract

Background: Usage of active fixation bipolar left ventricular (LV) leads represents an alternative approach to the more commonly used passive fixation quadripolar leads in cardiac resynchronization therapy (CRT). We compared a bipolar LV lead with a side screw for active fixation and passive fixation quadripolar LV leads.

Methods: Sixty-two patients were before CRT implantations randomly allocated to receive a bipolar (n = 31) or quadripolar (n = 31) LV leads. Speckle-tracking radial strain echocardiography was used to define the LV segment with latest mechanical activation as the target LV segment. The electrophysiological measurements and the capability to obtain a proximal position in a coronary vein placed over the target segment were assessed.

Results: Upon implantation, the quadripolar lead demonstrated a lower pacing capture threshold than the bipolar lead, but at follow-up, there was no difference. There were no differences in the LV lead implant times or radiation doses. The success rate in reaching the target location was not significantly different between the two LV leads.

Conclusions: The pacing capture thresholds were low, with no significant difference between active fixation bipolar leads and quadripolar leads. Active fixation leads did not promote a more proximal location of the stimulating electrode or a higher grade of concordance to the target segment than passive fixation leads.

Keywords: biventricular pacemaker; cardiac resynchronization therapy; heart failure.

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Conflict of interest statement

The authors have no conflict of interest, financial or otherwise.

Figures

FIGURE 1
FIGURE 1
Location and number of selected stimulating electrodes in different left ventricular segments in the active fixation lead group and in the quadripolar lead group
FIGURE 2
FIGURE 2
Right anterior oblique fluoroscopic views of two patients with an active fixation bipolar lead (A + B) and passive fixation quadripolar lead (C + D). On the coronary sinus (CS) venograms (A + C) the arrows indicate the target veins in lateral side branches from CS. The target vein is located in the target left ventricular segment determined from speckle tracking echocardiography. B: The final lead placement of an active fixation bipolar lead. The helix (H) is fixated proximal in the vein. The proximal electrode (PE) is located in a basal third left ventricular long‐axis position, and is used as the stimulating cathodal electrode. The distal electrode (DE) is in the mid third left ventricular long‐axis segment. The high voltage right ventricular defibrillator lead (DL) is located close to the apex of the right ventricle. D: The final lead placement of a quadripolar lead. The distal end (LV1) is wedged into a small side branch. The proximal electrode (LV4) is used as the stimulating cathodal electrode
FIGURE 3
FIGURE 3
A, The bipolar lead with distal angled shape has an exposed side screw for fixation located 15 mm proximal to the proximal electrode. The electrode separation is 21.0 mm. The maximum lead body diameter is 3.9 Fr. B, Demonstrates a close range view of the exposed side screw. C, The quadripolar leads: An S‐shaped lead, a straight lead with tines and a dual bend lead. The distances between the electrodes are 21 mm (LV1‐LV2), 1.3 mm (LV2‐LV3), and 21 mm (LV3‐LV4). The maximum lead body diameter is 5.3 Fr A + B: Photo by the author. C: Photo from the manufacturer
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