AIMS: Cardiac resynchronization therapy (CRT) is sometimes complicated by elevated pacing thresholds and phrenic nerve stimulation (PNS), both of which may require that the coronary sinus lead be repositioned. The purpose of this study was to evaluate the performance of a novel quadripolar electrode lead and cardiac resynchronization therapy-defibrillator (CRT-D) device that enables electrical repositioning, potentially obviating a lead reposition procedure. METHODS AND RESULTS: Patients indicated for CRT were enrolled and received a quadripolar electrode lead and CRT-D device (Quartetmodel 1458Q and Promote Q; St Jude Medical, Sylmar, CA, USA). Electrical data, and the presence of PNS during pacing from each left ventricular (LV) configuration, were documented at pre-hospital discharge and at 1 month. Seventy-five patients were enrolled and 71 were successfully implanted with a Quartetlead. Electrical measurements were stable over the follow-up period. Ninety-seven per cent (64 of 66) of patients had one or more programmable configurations with a threshold < 2.5 V and no PNS vs. 86% (57 of 66) if only conventional bipolar configurations were considered. Physicians were able to use the increased programming options to manage threshold changes and PNS. CONCLUSION: The new quadripolar electrode LV lead provides more programming options to address common problems faced when managing CRT patients. Electrical measurements from new vectors are comparable with conventional configurations. Furthermore, 11% of patients in the study suffered PNS on all conventional bipolar vectors.
AIMS: Cardiac resynchronization therapy (CRT) is sometimes complicated by elevated pacing thresholds and phrenic nerve stimulation (PNS), both of which may require that the coronary sinus lead be repositioned. The purpose of this study was to evaluate the performance of a novel quadripolar electrode lead and cardiac resynchronization therapy-defibrillator (CRT-D) device that enables electrical repositioning, potentially obviating a lead reposition procedure. METHODS AND RESULTS:Patients indicated for CRT were enrolled and received a quadripolar electrode lead and CRT-D device (Quartetmodel 1458Q and Promote Q; St Jude Medical, Sylmar, CA, USA). Electrical data, and the presence of PNS during pacing from each left ventricular (LV) configuration, were documented at pre-hospital discharge and at 1 month. Seventy-five patients were enrolled and 71 were successfully implanted with a Quartetlead. Electrical measurements were stable over the follow-up period. Ninety-seven per cent (64 of 66) of patients had one or more programmable configurations with a threshold < 2.5 V and no PNS vs. 86% (57 of 66) if only conventional bipolar configurations were considered. Physicians were able to use the increased programming options to manage threshold changes and PNS. CONCLUSION: The new quadripolar electrode LV lead provides more programming options to address common problems faced when managing CRT patients. Electrical measurements from new vectors are comparable with conventional configurations. Furthermore, 11% of patients in the study suffered PNS on all conventional bipolar vectors.
Authors: Antonios P Antoniadis; Ben Sieniewicz; Justin Gould; Bradley Porter; Jessica Webb; Simon Claridge; Jonathan M Behar; Christopher Aldo Rinaldi Journal: Curr Heart Fail Rep Date: 2017-10
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