A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing: initial experience

It has been reported that biatrial pacing can prevent the recurrence of atrial fibrillation. This technique requires a stable coronary sinus (CS) lead position for left atrial pacing. We report our experience of CS pacing with a specifically designed lead [Medtronic 2188 (n= 19)] and active fixation leads [Pacesetter Tendril (n=3), Medtronic Capsurefix (n=6)] in 21 patients with paroxysmal atrial fibrillation and a normal mean left atrial size of 39 mm (range 33-54 mm).

Using the Medtronic 2188 lead, successful initial CS canulation and lead positioning was achieved in all 19 patients. One patient developed subclavian vein thrombosis 3 months after initial implant. Eight patients (42%) experienced subsequent lead displacement (12 displacements in total). Of these, seven had their lead replaced with active fixation leads. In addition, two patients underwent active fixation lead implantation at first implant. CS canulation and lead positioning was successful in all nine patients. No patient suffered displacement of an active fixation lead. There were no complications in this group. Twelve of the 19 (66%) Medtronic 2188 leads were functioning at long-term follow-up (11 +/- 4 months) with a biatrial pacing threshold of 2.4 +/- 1 V. Eight of the nine (89%) active fixation leads were functioning at long-term follow-up (6 +/- 3 months) with a biatrial pacing threshold of 2.9 +/- 1.1 V. Using a combined approach 95% of patients had a functioning CS lead at long-term follow-up.

Active fixation leads can safely be used for left atrial pacing via the CS with good long-term pacing thresholds and stability.