INTRODUCTION: We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position. METHODS AND RESULTS: The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity score matched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location. CONCLUSION: We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead.

Boston Scientific Brussels Belgium

Boston Scientific Minneapolis Minnesota USA

Centre Hospitalier Universitaire Rennes France

CHU Hopital Michallon Grenoble France

Hamilton Health Sciences Population Health Research Institute McMaster University Hamilton Ontario Canada

Hospital de Santa Creu i Sant Pau Barcelona Spain

Institut Universitaire de Cardiologie et de Pneumologie de Québec Québec Canada

Institute for Clinical and Experimental Medicine Prague Czech Republic

J W Goethe University Frankfurt Germany

Karolinska Institute Stockholm Sweden

Klinikum Coburg GbmH Coburg Germany

Klinikum Kassel Kassel Germany

Leiden University Medical Center Leiden the Netherlands

Leviev Heart Center Sheba Medical Center Tel Hashomer Israel

Liverpool Heart and Chest Hospital Liverpool UK

Soroka Medical Center Ben Gurion University Beer Sheva Israel

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