Active Fixation Quadripolar Left Ventricular Leads in Cardiac Resynchronization Therapy: Clinical Utility at Mid-Term...

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Cardiac resynchronization therapy (CRT) is crucial for heart failure management.
• Left ventricular (LV) lead selection impacts CRT efficacy and safety.
• Comparing active vs. passive fixation LV leads is essential for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the mid-term performance of the Medtronic Attain Stability Quad (ASQ) quadripolar active fixation LV lead.
• To compare ASQ lead performance against conventional quadripolar passive fixation leads (non-ASQ).
• To assess lead-related complications and implantation success rates.

Main Methods:

• A comparative study of 300 patients undergoing CRT implantation with LV leads.
• Patients were divided into ASQ (n=159) and non-ASQ (n=141) groups.
• Analysis of complications including pacing capture threshold, phrenic nerve stimulation, and lead dislodgement over a median follow-up of 834 days.

Main Results:

• The ASQ group had significantly lower LV lead-related complications (19%) compared to the non-ASQ group (32%).
• LV lead dislodgement occurred exclusively in the non-ASQ group.
• Elevated pacing capture threshold was significantly lower in the ASQ group (8% vs. 26%).
• Kaplan-Meier and Cox regression analyses confirmed reduced lead-related complications with ASQ leads.

Conclusions:

• The ASQ lead demonstrated superior safety and performance compared to non-ASQ leads in CRT.
• Fewer reinterventions and setting adjustments were needed for ASQ leads.
• The ASQ lead is a recommended choice for CRT device implantation.