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Fabian Schiedat, Harilaos Bogossian, Dominik Schöne, Assem Aweimer, Polykarpos C. Patsalis, Christoph Hanefeld, Andreas Mügge, Axel Kloppe

• \(\bf Background:\) Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL. \(\bf Methods:\) We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed. \(\bf Results:\) BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 \(\pm\) 4.1 Fr vs. 4.1 \(\pm\) 2.3 Fr, \(\it p\) < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 \(\pm\) 10.5 min, vs. QuadPFL: 18.9 \(\pm\) 8.9 min, \(\it p\) = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, \(\it p\) = 0.82) and New York Heart Association (66.7 vs. 62.2%, \(\it p\) = 0.32). At median FU of 48 months (IQR: 44–54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, \(\it p\) < 0.05). Electrical parameters were stable during FU in both groups without significant differences. \(\it Conclusion:\) BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL.