Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing)

ABSTRACT

Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters.

Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation.

Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous.

Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators’ majority want to disposition all kind of leads, although quadripolar leads are the favorites.

KEYWORDS:

• Lead choice
• left ventricular lead
• right atrial lead
• right ventricular lead
• survey

Declaration of interest

M Ziacchi has received lecture fees from Boston Scientific, Medtronic, Biotronik and Boehringer Ingelheim; G Zanotto has received lecture fees from Boston Scientific, Biotronik, Pfizer and Boehringer Ingelheim; M Landolina has received lecture fees from Boston Scientific, LivaNova, Medtronic, Boehringer Ingelheim, Bayer and Pfizer; R De Ponti has received lecture fees from Biotronik and Biosense Webster and research grant from Actelion, his Institution has received educational grants from Abbott, Biotronik, Boston Scientific, Medtronic and Biosense Webster; RP Ricci has received minor consultancy fees by Medtronic and Boston Scientific. G Boriani reported lecture fees from Boston, Biotronik and Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This paper is not funded.