Abstract 16980: Real World Performance of a Conduction System Pacing Lead

Abstract

Introduction: With the shift towards conduction system pacing (CSP), a technique that preserves ventricular synchrony unlike standard right ventricular pacing (RVP), the use of the smaller diameter fixed-helix Medtronic 3830 4Fr Select Secure lead and its’ special delivery catheter has dramatically increased. The near and long-term performance of the 3830 lead in a large real-world setting remains poorly characterized. Thus, we evaluated our experience with the 3830 lead in comparison to the Medtronic 6Fr stylet-driven active fixation CapSureFix Novus 5076 lead used for conventional RVP. Hypothesis: The performance of the 3830 CSP lead is equivalent to that of the 5076 RVP lead. Methods: Patients with 3830 CSP or 5076 RVP leads implanted at our institution between January 1st, 2018 and March 1st, 2022 were included. All patients were followed at our institution and lead complications, revisions, explants, and upgrades to present day were tracked. Groups were compared using the chi-squared and Fisher’s exact tests in R 4.2.3. Results: The outcomes for 2,077 patients receiving either a 3830 CSP lead (n=1,018) or a 5076 RVP lead (n=1,059) are shown in the table. Initially, 13 (1.3%) 3830 leads could not be implanted vs. 3 (0.3%) 5076 leads (p=0.011). Subsequently, however, total revisions were similar between groups (p=0.20), and there were no significant differences in dislodgement, infection, or need for upgrade. One 3830 lead fractured and was replaced; otherwise, there were no lead failures in either group. The distribution of time from implant to event was also similar (p=.376). Conclusion: The long-term performances of the 3830 and 5076 leads are similarly satisfactory. A small proportion of 3830 leads could not be implanted, but overall septal or CSP was reliably achieved with few complications or need for lead revision or upgrade.