Matteo Ziacchi1, Davide Saporito2, Marco Zardini3, Mario Luzi4, Fabio Quartieri5, Gianluigi Morgagni6, Elia De Maria7, Matteo Bertini8, Valeria Carinci9, Giuseppe Boriani1, Mauro Biffi1. 1. Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 2. Division of Cardiology, Infermi Hospital, Rimini, Italy. 3. Division of Cardiology, University Hospital, Parma, Italy. 4. Cardiovascular Department, Ospedali Riuniti, Ancona, Italy. 5. Division of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 6. Division of Cardiology, Macerata Hospital, Macerata, Italy. 7. Division of Cardiology, Ramazzini Hospital, Carpi, Italy. 8. Division of Cardiology, S.Anna Hospital, Ferrara, Italy. 9. Division of Cardiology, Maggiore Hospital, Bologna, Italy.
Abstract
BACKGROUND: To understand the impact of a quadripolar left ventricular (LV) lead on reverse remodeling and phrenic nerve stimulation (PNS) in congestive heart failure patients treated by cardiac resynchronization therapy at 8-month follow-up (FU). METHODS: One hundred and fifty-eight patients received an LV Medtronic Performa lead (Medtronic Inc., Minneapolis, MN, USA) and were reevaluated at FU by echocardiography and measurement of electrical parameters. RESULTS: A targeted LV lead placement was achieved in 140 (89%) patients. Super responders and responders were 76 (50%) and 26 (18%), respectively, at FU; seven (4%) died and 13 (8%) were hospitalized for any cause. Nonischemic etiology was the only independent predictor of reverse remodeling. The configurations available only with the Performa leads reduced PNS occurrence at 8 V@0.4 ms from 43 (27%) to 14 (9%) of patients at implantation, and from 44 (28%) to 19 (12%) at last FU, compared to configurations available with bipolar leads. Patients with detectable PNS had >10/16 pacing configurations with a PNS safety margin >2 V both at implantation and at FU. During FU 16 (10%) patients had an adverse event possibly related to the lead or to modification of the underlying heart disease but 99% of these events were fixed by reprogramming of the pacing vector. CONCLUSIONS: Performa Lead enables an increased capability to achieve a targeted lead positioning in the broad clinical scenario of large- and small-volume implanting centers, with a relevant impact on the occurrence of reverse remodeling compared to literature data. The enhanced management of PNS resulted in a dislodgement rate of only 1%.
BACKGROUND: To understand the impact of a quadripolar left ventricular (LV) lead on reverse remodeling and phrenic nerve stimulation (PNS) in congestive heart failurepatients treated by cardiac resynchronization therapy at 8-month follow-up (FU). METHODS: One hundred and fifty-eight patients received an LV Medtronic Performa lead (Medtronic Inc., Minneapolis, MN, USA) and were reevaluated at FU by echocardiography and measurement of electrical parameters. RESULTS: A targeted LV lead placement was achieved in 140 (89%) patients. Super responders and responders were 76 (50%) and 26 (18%), respectively, at FU; seven (4%) died and 13 (8%) were hospitalized for any cause. Nonischemic etiology was the only independent predictor of reverse remodeling. The configurations available only with the Performa leads reduced PNS occurrence at 8 V@0.4 ms from 43 (27%) to 14 (9%) of patients at implantation, and from 44 (28%) to 19 (12%) at last FU, compared to configurations available with bipolar leads. Patients with detectable PNS had >10/16 pacing configurations with a PNS safety margin >2 V both at implantation and at FU. During FU 16 (10%) patients had an adverse event possibly related to the lead or to modification of the underlying heart disease but 99% of these events were fixed by reprogramming of the pacing vector. CONCLUSIONS: Performa Lead enables an increased capability to achieve a targeted lead positioning in the broad clinical scenario of large- and small-volume implanting centers, with a relevant impact on the occurrence of reverse remodeling compared to literature data. The enhanced management of PNS resulted in a dislodgement rate of only 1%.
Authors: M Ziacchi; I Diemberger; A Corzani; C Martignani; A Mazzotti; G Massaro; C Valzania; C Rapezzi; G Boriani; M Biffi Journal: Sci Rep Date: 2018-09-05 Impact factor: 4.379