Single-Pass VDD Pacing Lead for Cardiac Resynchronization Therapy: A Reliable Alternative

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Cardiac resynchronization therapy (CRT) systems typically utilize atrial and ventricular leads.
• Simplifying CRT by using a Ventricular-Dual-Dual (VDD) pacing lead, excluding the atrial lead, is being explored.
• Potential drawbacks include atrial undersensing and Ventricular-Ventricular-Inhibition (VVI) pacing, with limited existing literature.

Purpose of the Study:

• To analyze the benefits and technical safety of VDD-CRT systems.
• To compare VDD-CRT systems with traditional Dual-Dual-Dual (DDD)-CRT systems.
• To evaluate VDD-CRT in patients with unfavorable venous anatomy.

Main Methods:

• A retrospective study comparing VDD-CRT (n=50) with DDD-CRT (n=103+49) systems implanted between 2000-2020.
• Analysis of functional parameters in selected subgroups: VDD-CRT (n=27+47) and DDD-CRT (n=36).
• Focus on complication rates, atrial undersensing, and VVI pacing percentages.

Main Results:

• A trend towards lower complication rates, especially infections, was observed with VDD-CRT systems (2000-2016, p=0.0048).
• Similar functional CRT pacing results were achieved with proper programming, and atrial undersensing was minimal (p=0.65).
• VVI pacing occurred in only 1.7 ± 2.24% of the time in VDD-systems.

Conclusions:

• VDD-CRT systems present a safe and effective alternative for patients with less favorable venous anatomy.
• These systems demonstrate comparable functional parameters to DDD-CRT systems.
• The technical safety and reduced complication rates support the use of VDD-CRT in specific patient populations.