The impact of defibrillation lead position on electrical parameters measured perioperatively and in long-term follow-up

<ns3:p>Introduction: Implantable cardioverter-defibrillators (ICD) with transvenous defibrillation leads remain the leading therapeutic method in the treatment of patients at high risk of sudden cardiac death. The lack of clear data confirming the superiority of any position in the right ventricle for placement of the defibrillation lead results in significant individualization of practice between operators.Aims: The study aims to assess the electrical parameters of defibrillation leads obtained intraoperatively and in the long-term follow-up, depending on the position of the lead in the right ventricle.Methods: Between 2018 and 2021, consecutive patients were enrolled in an observational study after the implantation of a device with defibrillation capability. Electrical parameters were measured during each control visit, 3 months after the implantation procedure, and then every 6-months during follow-up visits. The data regarding intraprocedural course (procedure time, an X-ray time, intraprocedural electrical parameters) were collected retrospectively. The patients were divided into two groups depending on the placement of the defibrillation lead in the right ventricle: the RVA (right ventricular apex group) and the non-RVA group consisting of patients with the lead implanted in the alternative position.Results: Of the 167 patients included in the study, 90 patients (54%) were assigned to the RVA group and 77 patients (46%) to the non-RVA group. The mean follow-up time was 26.1 12.6 months. Electrical parameters (pacing threshold, ventricular sensing amplitude and impedance) observed intraoperatively and measured on the first day following the procedure did not differ significantly between the groups. There was no significant difference in the incidence of abnormal electrical parameters between the apical and non-apical electrodes throughout the observation period. A total of 4 patients (4%) in the RVA group and 3 patients (4%) in the non-RVA group required lead replacement during the follow-up period.Conclusions: The position of the defibrillation lead has no clinically significant influence on the electrical parameters observed both intraoperatively and in long-term follow-up.</ns3:p>