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Improved implant and postoperative lead performance in CRT-D patients implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study

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Abstract

Purpose

Small single-center comparative studies suggest improved outcomes in cardiac resynchronization therapy (CRT) patients implanted with a quadripolar left ventricular (LV) lead in comparison with non-quadripolar (bipolar) leads. This study represents the first large multicenter prospective registry comparing implant and 6-month postoperative lead performance following CRT-defibrillator (CRT-D) implantation with quadripolar vs. bipolar leads.

Methods

During a 39-month period, 418 consecutive patients having CRT-D implantation attempts with either a quadripolar (n = 230) or bipolar LV lead (n = 188) were enrolled in the registry. The primary outcome of the study was LV lead failure defined as any abnormality, excluding infection, resulting in surgical lead revision or CRT termination. Additionally, operative and follow-up data were analyzed for significant difference between groups.

Results

Baseline characteristics of both groups were similar. In 72.9 % of quadripolar leads versus 65.0 % of bipolar leads, the LV lead successfully engaged the predefined ideal target side branch (p = 0.47). Implant duration and fluoroscopy times were significantly shorter when a quadripolar lead was used (p = 0.007 and p = 0.001, respectively). The primary end point occurred in six patients (2.7 %) in the quadripolar group and in 14 patients (8.0 %) in the bipolar group (p = 0.02). Clinically significant phrenic nerve stimulation (PNS) occurred in 4.6 vs. 14.2 % of quadripolar vs. bipolar patients, respectively (p = 0.002); all PNS were resolved noninvasively through programming in the quadripolar group vs. 84 % in bipolar group (p = 0.75). The use of a bipolar lead was associated with a higher risk of surgical LV lead revision (6.3 vs. 2.3 %; p = 0.057) and a higher incidence of dislodgment (5.7 vs. 2.7 %; p = 0.16).

Conclusions

This multicenter study demonstrates that the use of a quadripolar LV lead results in significantly lower rates of lead-related problems and reduced procedural and fluoroscopic times for biventricular system implantation. This has important implications for LV pacing lead choice.

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Acknowledgments

The authors thank Cecilia Rubaudo for her assistance in the preparation of this manuscript.

Conflict of interest

Dr. Forleo and Dr. Santini received speaker honoraria from St. Jude Medical. Dr. Natale received speaker honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Life Watch. The remaining authors have no disclosures.

Funding sources

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, University of Rome “Tor Vergata”, Rome, Italy

    Giovanni B. Forleo, Germana Panattoni, Domenico Sergi, Manfredi Tesauro, Lida P. Papavasileiou, Luca Santini & Francesco Romeo

  2. Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY, USA

    Luigi Di Biase

  3. Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA

    Luigi Di Biase & Andrea Natale

  4. Department of Cardiology, University of Foggia, Foggia, Italy

    Luigi Di Biase

  5. Arrhythmia and Electrophysiology Center, St. Ambrogio Clinical Institute, Milan, Italy

    Massimo Mantica

  6. Catholic University of Sacred Heart, Campobasso, Italy

    Quintino Parisi

  7. Policlinico Casilino, Rome, Italy

    Annamaria Martino & Leonardo Calò

  8. Cardiac Arrhythmia and Heart Failure Center, St. Camillo-Forlanini Hospital, Rome, Italy

    Augusto Pappalardo

  9. Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy

    Claudio Tondo

Authors
  1. Giovanni B. Forleo
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  2. Luigi Di Biase
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  3. Germana Panattoni
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  4. Massimo Mantica
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  6. Annamaria Martino
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  7. Augusto Pappalardo
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  9. Manfredi Tesauro
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  10. Lida P. Papavasileiou
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  11. Luca Santini
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  12. Leonardo Calò
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  13. Claudio Tondo
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  14. Andrea Natale
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  15. Francesco Romeo
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Corresponding author

Correspondence to Giovanni B. Forleo.

Additional information

A preliminary report of this work was presented as an oral communication at the 35th Annual Scientific Session of the Heart Rhythm Society, San Francisco, CA, 2014.

The following Italian institutions and investigators (listed in alphabetic order) participated in the study. Azienda Ospedaliera San Camillo-Forlanini, Roma: A Avella, P De Girolamo, F Laurenzi, A Pappalardo. Centro Cardiologico Monzino IRCCS (Milano): M Casella; A Dello Russo; G Fassini; C Tondo. Centro di Ricerche e Formazione ad Alta Tecnologia Nelle Scienze Biomediche “Giovanni Paolo II”, Campobasso: L Messano, Q Parisi, M Santamaria. Istituto Clinico Sant’Ambrogio, Gruppo San Donato, Milano: V De Sanctis, M Mantica, S Panigada. Policlinico Casilino, Roma: A Martino, L De Luca, L Calò. Policlinico Universitario, Foggia: L Di Biase. Policlinico Universitario Tor Vergata, Roma: DG Della Rocca, G Magliano, GB Forleo, LP Papavasileiou, A Politano, F Romeo, L Santini, G Panattoni, D Sergi, M Tesauro.

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Forleo, G.B., Di Biase, L., Panattoni, G. et al. Improved implant and postoperative lead performance in CRT-D patients implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study. J Interv Card Electrophysiol 42, 59–66 (2015). https://doi.org/10.1007/s10840-014-9956-1

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  • DOI: https://doi.org/10.1007/s10840-014-9956-1

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