INCIDENCE OF PERFORATION AND OTHER MECHANICAL COMPLICATIONS DURING DUAL ACTIVE FIXATION

The intraoperative and early postoperative mechanical complications of a procedure combining an atrial screw-in lead and a ventricular screw -in lead insertion were prospectively evaluated. The procedure was per formed in 119 consecutive patients (mean age 69 +/- 8 years), at first implant in 100 patients and at reoperation in 19. Nine patients had p reviously undergone cardiac surgery and three underwent transvenous ve ntricular defibrillator implantation. The double sets of leads were in troduced through 2 separate veins in 5 cases, through a single venous route in 114 cases, using a percutaneous approach in 75 cases and a ve nous cutdown in 49, and a guidewire procedure following the venotomy i n 19. The screw was mannitol coated in 102 cases, exposed in 111, and extendable/retractable in 25. The fixation of the ventricular lead was performed at the apex in 108 cases, at the outflow tract in 11, and w as followed by the fixation of the atrial lead at the appendage in 112 cases and at the lateral wall in 7 cases. The lead positioning and fi xation were successful at first attempt in 103 cases and after repeate d lead manipulation in 19 cases. The rotational torque could be transf erred to the helix in all cases except in one patient who required a s econd vein puncture. Unintentional fixation in the ventricular chamber with subsequent failure to remove the lead occurred in one patient. R eoperation for lead dislodgment was required in two patients. In one p atient, symptomatic pericarditis with pericardial effusion was observe d 1 day after the procedure and resolved spontaneously. Dual active fi xation is feasible with a low incidence of mechanical complications.