AIMS: To compare both short- and long-term stability and pacing parameters of CS leads. Long-term maintenance of coronary sinus (CS) pacing lead position has not yet been assessed by serial X-ray digital imaging. METHODS AND RESULTS: Using X-ray digital imaging in anteroposterior and left lateral views, we performed analysis of the CS lead position at the end of the implantation procedure, 48 h following implantation and after 12 months in 93 consecutive patients. Attain OTW leads, QuickSite leads and EasyTrak leads were implanted in 44, 12 and 37 cases, respectively. X-ray detectable late CS lead dislodgement was observed in 8 cases (8.6%) during 12-months follow-up. Dislodgment was once accompanied by loss of capture and need for repositioning. Another two major dislodgements occurred without any threshold change. Five (5.4%) minor dislocations occurred with either a decrease or an increase in pacing threshold. Left ventricular (LV) pacing threshold was changed by >or= 1 V after 12 months in 14 patients (15%) when compared to values 48 h after implantation. All but one case of >or= 1 V threshold change (either positive or negative) occurred without any radiological evidence of lead displacement. LV pacing threshold was significantly higher than RV pacing threshold at both baseline and during follow-up. Leads from all three manufacturers had comparable pacing thresholds 12 months following implantation. CONCLUSION: The position of CS leads may change during 1-year follow-up. However, it rarely required reoperation in the selected group of patients. Long-term pacing parameters between different manufacturers are comparable. Increase in pacing threshold is not a reliable marker of CS lead dislodgement.

Department of Internal Medicine University Hospital Olomouc Czech Republic

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Capture threshold of bipolar and unipolar pacing of left ventricle via coronary sinus branch: longitudinal study