A Novel Quadripolar Active Fixation Left-Ventricular Pacing Lead for CardiacResynchronization Therapy: Initial United Kingdom Experience.

Abstract

This study sought to assess immediate and short-term performance of the Medtronic Attain Stability Quadripolar 4798 lead (Medtronic, Dublin, Ireland). Cardiac resynchronization therapy (CRT) is an established treatment for appropriately selected patients with left ventricular (LV) systolic dysfunction. The most common reason for failure to implant a lead is the lack of a suitable epicardial vein, due either to an absent vessel in the target site, an unacceptably high threshold, lead instability, phrenic nerve stimulation, or a combination of reasons. In August 2017, a novel quadripolar active fixation LV lead (Medtronic) was released. This paper reports the initial clinical experience with lead implantation and specifically immediate and short-term pacing parameters across 3 United Kingdom centers. Consecutive patients eligible for CRT were deemed suitable for this lead. Immediate and short-term lead performance data regarding LV threshold, impedance, and displacement rates were collected at standard pacing checks (1day, 5weeks, 3months, and 9months post-implantation). CRT using this lead was attempted in 82 cases and was successful in 81 cases (98.8%). LV thresholds and impedance levels were 1.22 ± 0.75V and 737 ± 319Ω at implantation; 1.16 ± 0.71V and 597 ± 218Ω at day 1; 1.02 ± 0.48V and 579 ± 148Ω at week 6; 0.98 ± 0.49V and 569 ± 133Ω at 3months; and 1.06 ± 0.48V and 570 ± 140Ω at 9months. As of the publication of this paper, no LV lead has been displaced. CRT using the Medtronic lead was successful in more than 98% of the patients. Short-to-medium-term data regarding lead performance and stability were excellent, with zero displacements as of the publication of this paper.