Introduction: The choice between active vs passive fixation leads at the time of pacemaker implantation is primarily based on operators experience. However, there is a paucity of data on the clinical benefits such as device longevity and complication rate of using either type of lead fixation system.
Methods: Consecutive patients who received a pacemaker at our academic center over a 6 month period were retrospectively analyzed. Either a passive or active ventricular lead chosen based on operators preference. Pacing threshold and impedance were collected 3 weeks post implant and used to calculated device longevity based on pacing at 60 beats per minute with pulse width of 0.4ms in a single chamber St. Jude Accent device. Longevity calculation also included safety margin at twice and three times pacing threshold, and pacing at 50% and 100%. Lead dislodgment rate was also collected.
Results: Overall, 362 patients underwent pacemaker implantation (197 passive). At 3 weeks, 311 patients (167 passive) had complete follow up. Patient characteristics in both groups were similar in terms of age, gender and pacemaker indication. Both mean pacing threshold and impedance were significantly lower in the passive lead group compared to active lead group. Depending on percentage of pacing and safety margin parameters, Passive fixation lead could potentially save up to 2 years in battery life compared to active fixation lead (P< 0.001) (Table 1). Lead dislodgment rate was not significantly different among groups (2.5% vs 4.2%, p=NS).
Conclusions: Passive ventricular leads have significantly lower pacing thresholds and may potentially prolong estimated battery life by 2 years. Passive ventricular leads did not have an increased risk of dislodgment.