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

This study aimed to evaluate the performance of the Medtronic Attain Stability Quad (ASQ) quadripolar active fixation left ventricular (LV) lead compared with conventional quadripolar passive fixation leads (non-ASQ) in a mid-term follow-up study.

A total of 300 consecutive patients (ASQ 159, non-ASQ 141) who underwent attempted and successful cardiac resynchronization therapy (CRT) device implantation with an LV lead between January 2018 and October 2023 were enrolled. The median follow-up period was 834 days (766 days in the ASQ group and 938 days in the non-ASQ group). Complications including elevated pacing capture threshold (PCT), phrenic nerve stimulation (PNS) and LV lead dislodgement were analyzed in the period from implantation to the first outpatient visit after hospital discharge. The incidence of LV lead-related complications was significantly lower in the ASQ group (19%) than in the non-ASQ group (32%) (p = 0.014). Specifically, LV lead dislodgement occurred in the non-ASQ group only, and elevated PCT was significantly lower in the ASQ group (8% vs. 26%, p < 0.001). Kaplan-Meier analysis confirmed a significantly lower incidence of LV lead-related complications in the ASQ group (log-rank p < 0.001). Cox multivariate regression analysis showed a significant reduction in lead-related complications associated with ASQ (HR: 0.31, 95% CI: 0.19-0.51, p < 0.001).

The ASQ group exhibited fewer LV lead-related complications requiring reintervention and setting changes than the non-ASQ group. The ASQ may be accepted as the first choice for CRT device implantation.