Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy

Background: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead di...

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Autores principales:	Fabian Schiedat, Harilaos Bogossian, Dominik Schöne, Assem Aweimer, Polykarpos C. Patsalis, Christoph Hanefeld, Andreas Mügge, Axel Kloppe
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	cardiac resynchronisation therapy active fixation left ventricular lead lead dislodgement biventricular pacing Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/dd46980af0144fcf8da1d6d0494ee57a
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spelling	oai:doaj.org-article:dd46980af0144fcf8da1d6d0494ee57a2021-11-22T04:44:41ZLong-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy2297-055X10.3389/fcvm.2021.734666https://doaj.org/article/dd46980af0144fcf8da1d6d0494ee57a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.734666/fullhttps://doaj.org/toc/2297-055XBackground: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL.Methods: We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed.Results: BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 ± 4.1 Fr vs. 4.1 ± 2.3 Fr, p < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 ± 10.5 min, vs. QuadPFL: 18.9 ± 8.9 min, p = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, p = 0.82) and New York Heart Association (66.7 vs. 62.2%, p = 0.32). At median FU of 48 months (IQR: 44–54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, p < 0.05). Electrical parameters were stable during FU in both groups without significant differences.Conclusion: BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL.Fabian SchiedatFabian SchiedatHarilaos BogossianDominik SchöneAssem AweimerPolykarpos C. PatsalisChristoph HanefeldAndreas MüggeAxel KloppeFrontiers Media S.A.articlecardiac resynchronisation therapyactive fixationleft ventricular leadlead dislodgementbiventricular pacingDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiac resynchronisation therapy active fixation left ventricular lead lead dislodgement biventricular pacing Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	cardiac resynchronisation therapy active fixation left ventricular lead lead dislodgement biventricular pacing Diseases of the circulatory (Cardiovascular) system RC666-701 Fabian Schiedat Fabian Schiedat Harilaos Bogossian Dominik Schöne Assem Aweimer Polykarpos C. Patsalis Christoph Hanefeld Andreas Mügge Axel Kloppe Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy
description	Background: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL.Methods: We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed.Results: BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 ± 4.1 Fr vs. 4.1 ± 2.3 Fr, p < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 ± 10.5 min, vs. QuadPFL: 18.9 ± 8.9 min, p = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, p = 0.82) and New York Heart Association (66.7 vs. 62.2%, p = 0.32). At median FU of 48 months (IQR: 44–54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, p < 0.05). Electrical parameters were stable during FU in both groups without significant differences.Conclusion: BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL.
format	article
author	Fabian Schiedat Fabian Schiedat Harilaos Bogossian Dominik Schöne Assem Aweimer Polykarpos C. Patsalis Christoph Hanefeld Andreas Mügge Axel Kloppe
author_facet	Fabian Schiedat Fabian Schiedat Harilaos Bogossian Dominik Schöne Assem Aweimer Polykarpos C. Patsalis Christoph Hanefeld Andreas Mügge Axel Kloppe
author_sort	Fabian Schiedat
title	Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy
title_short	Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy
title_full	Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy
title_fullStr	Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy
title_full_unstemmed	Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy
title_sort	long-term performance comparison of bipolar active vs. quadripolar passive fixation leads in cardiac resynchronisation therapy
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/dd46980af0144fcf8da1d6d0494ee57a
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Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy

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