Effective long-term left atrial pacing using regular screw-in leads implanted within the coronary sinus

Area of Science:

• Cardiology
• Biomedical Engineering
• Electrophysiology

Background:

• Passive-fixation leads in the coronary sinus (CS) for left atrial (LA) pacing are prone to dislodgement.
• Anatomical features of the proximal CS suggest potential for secure lead placement.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of active-fixation (screw-in) leads in the CS for LA pacing.
• To compare screw-in leads against passive-fixation leads regarding lead dislodgement and pacing parameters.

Main Methods:

• A comparative study involving 33 patients undergoing dual-chamber pacemaker implantation.
• Left atrial pacing was achieved using either passive-fixation leads (7 patients) or screw-in leads (26 patients) positioned in the CS.
• Pacing thresholds and adverse events were monitored for acute and chronic outcomes.

Main Results:

• Passive-fixation leads were abandoned due to a high dislodgement rate (42%).
• Screw-in leads in the CS showed no instances of pericardial effusion, dislodgement, or diaphragmatic stimulation.
• Steroid-eluting screw-in leads demonstrated significantly lower chronic pacing thresholds compared to non-eluting leads.

Conclusions:

• Regular screw-in leads implanted in the coronary sinus provide effective and safe long-term left atrial pacing.
• Active-fixation leads in the CS eliminate the risk of lead dislodgement associated with passive-fixation methods.
• Steroid elution may further optimize pacing parameters with active-fixation leads in the CS.