BACKGROUND: Flexible left ventricular (LV) pacing configurations are a useful component of cardiac resynchronization therapy (CRT) systems for preventing high LV pacing thresholds and phrenic nerve stimulation (PNS). A quadripolar LV lead has recently been designed with the purpose of allowing more choices in lead placement location and programming capability. OBJECTIVE: To verify the effectiveness of quadripolar LV leads compared to conventional bipolar LV leads implant outcomes. METHODS: Forty-five consecutive patients underwent implantation with either the quadripolar (n = 22; quadripolar group) or a conventional bipolar LV lead (n = 23; bipolar group). The primary outcome of the study was LV lead failure, defined as the need for lead revision or reprogramming during the first 3 months after implantation. Additionally, operative and follow-up data were prospectively noted and checked for significance between groups. RESULTS: The implantation success rate in both groups was 100%. Baseline characteristics, procedure duration, and fluoroscopy time did not differ significantly between groups. Two lead dislodgments (requiring reoperation) and 4 clinical PNS were reported in the bipolar group; reprogramming of the device was sufficient to prevent PNS in 3 patients, the fourth is pending solution. One PNS successfully managed noninvasively occurred in the quadripolar group. By Kaplan-Meier analysis, event-free survival for the combined primary outcome was significantly lower in patients with quadripolar leads (P = .037). CONCLUSION: This prospective, controlled study provides strong evidence that CRT with the quadripolar LV lead results in low rates of dislocations and phrenic nerve stimulation.
BACKGROUND: Flexible left ventricular (LV) pacing configurations are a useful component of cardiac resynchronization therapy (CRT) systems for preventing high LV pacing thresholds and phrenic nerve stimulation (PNS). A quadripolar LV lead has recently been designed with the purpose of allowing more choices in lead placement location and programming capability. OBJECTIVE: To verify the effectiveness of quadripolar LV leads compared to conventional bipolar LV leads implant outcomes. METHODS: Forty-five consecutive patients underwent implantation with either the quadripolar (n = 22; quadripolar group) or a conventional bipolar LV lead (n = 23; bipolar group). The primary outcome of the study was LV lead failure, defined as the need for lead revision or reprogramming during the first 3 months after implantation. Additionally, operative and follow-up data were prospectively noted and checked for significance between groups. RESULTS: The implantation success rate in both groups was 100%. Baseline characteristics, procedure duration, and fluoroscopy time did not differ significantly between groups. Two lead dislodgments (requiring reoperation) and 4 clinical PNS were reported in the bipolar group; reprogramming of the device was sufficient to prevent PNS in 3 patients, the fourth is pending solution. One PNS successfully managed noninvasively occurred in the quadripolar group. By Kaplan-Meier analysis, event-free survival for the combined primary outcome was significantly lower in patients with quadripolar leads (P = .037). CONCLUSION: This prospective, controlled study provides strong evidence that CRT with the quadripolar LV lead results in low rates of dislocations and phrenic nerve stimulation.
Authors: Giovanni B Forleo; Luigi Di Biase; Germana Panattoni; Massimo Mantica; Quintino Parisi; Annamaria Martino; Augusto Pappalardo; Domenico Sergi; Manfredi Tesauro; Lida P Papavasileiou; Luca Santini; Leonardo Calò; Claudio Tondo; Andrea Natale; Francesco Romeo Journal: J Interv Card Electrophysiol Date: 2014-12-13 Impact factor: 1.900
Authors: Jonathan M Behar; Julian Bostock; Matthew Ginks; Tom Jackson; Manav Sohal; Simon Claridge; Reza Razavi; Christopher Aldo Rinaldi Journal: J Interv Card Electrophysiol Date: 2015-01-28 Impact factor: 1.900
Authors: Mohit K Turagam; Muhammad R Afzal; Sandia Iskander; Luigi Di Biase; Andrea Natale; Dhanunjaya Lakkireddy Journal: J Atr Fibrillation Date: 2016-08-31