An active fixation quadripolar left ventricular lead for cardiac resynchronisation therapy with reduced post-operative complication rates.

BACKGROUND: The rate of left ventricular (LV) lead displacement after cardiac resynchronization therapy (CRT) remains high despite improvements in lead technology. In 2017, a novel quadripolar lead with active fixation technology became available in the UK. METHODS: This was a retrospective, observational study analysing device complications in 476 consecutive patients undergoing successful first-time implantation of a CRT device at a tertiary centre from 2017 to 2020. RESULTS: Both active (n=135) and passive fixation (n=341) quadripolar leads had similar success rates for implantation (99.3% vs 98.8%, p=1.00), although the pacing threshold (0.89 [0.60-1.25] vs 1.00 [0.70-1.60] V, p=0.01) and lead impedance (632 [552-794] vs 730 [636-862] Ohms, p<0.0001) were significantly lower for the active fixation lead. Patients receiving an active fixation lead had a reduced incidence of lead displacement at 6 months (0.74% vs 4.69%, p=0.036). There was no significant difference in the rate of right atrial (RA) and right ventricular (RV) lead displacement between the two groups (RA: 1.48% vs 1.17%, p=0.68; RV: 2.22% vs 1.76%, p=0.72). Reprogramming the LV lead after displacement was unsuccessful in most cases (successful reprogramming: Active fix = 0/1, Passive fix = 1/16) therefore nearly all patients required a repeat procedure. As a result, the rate of intervention within 6 months for lead displacement was significantly lower when patients were implanted with the active fixation lead (0.74% vs 4.40%, p=0.049). CONCLUSION: The novel active fixation lead in our study has a lower incidence of lead displacement and re-intervention compared to conventional quadripolar leads for CRT. This article is protected by copyright. All rights reserved.