Cardiac Resynchronization Therapy With a Quadripolar Electrode Lead Decreases Complications at 6 Months

Boriani, Giuseppe; Connors, Sean P.; Kalarus, Zbigniew; Lemke, Bernd; Mullens, Wilfried; Osca, Joaquín; Raatikainen, Pekka; Gazzola, Carlo; Farazi, Taraneh G.; Leclercq, Christophe

doi:10.1016/j.jacep.2015.10.004

Cited by 38 publications

(33 citation statements)

References 24 publications

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“…In the MORE‐CRT (More Options Available With a Quadripolar LV Lead Provide In‐Clinic Solutions to CRT Challenges) trial, 1074 patients undergoing CRT‐D were randomized in 1:2 ratio to bipolar leads or QUAD. Freedom from the composite end point of intraoperative and postoperative LV lead–related events at 6 months was greater with QUAD than with bipolar leads (83.0% versus 74.4%, P =0.0002), but this was because of differences in the intraoperative rather than postoperative events . In the present study, which involved a longer follow‐up period, QUAD was associated with a lower incidence of PNS and LV lead displacement.…”

Section: Discussionmentioning

confidence: 47%

“…Freedom from the composite end point of intraoperative and postoperative LV lead-related events at 6 months was greater with QUAD than with bipolar leads (83.0% versus 74.4%, P=0.0002), but this was because of differences in the intraoperative rather than postoperative events. 10 In the present study, which involved a longer follow-up period, QUAD was associated with a lower incidence of PNS and LV lead displacement. This might be expected in view of the fact that vector optimization almost invariably eliminates PNS in patients who initially have PNS with QUAD.…”

Section: Lead Re-interventionsmentioning

confidence: 44%

“…[5][6][7][8][9] Since their launch in 2010, quadripolar LV leads (QUAD) have been considered by implanters as a "game-changer," even before robust clinical evidence emerged in their favor. Observational studies and a randomized, controlled trial 10 have since shown that QUAD is associated with higher implant success rates and lower rates of re-interventions for LV lead displacement or PNS. 11,12 Some observational studies have suggested that CRT-D using QUAD programmed to single-site LV pacing also improves survival.…”

mentioning

confidence: 99%

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Cardiac Resynchronization Therapy Using Quadripolar Versus Non‐Quadripolar Left Ventricular Leads Programmed to Biventricular Pacing With Single‐Site Left Ventricular Pacing: Impact on Survival and Heart Failure Hospitalization

Leyva

Zegard

Qiu

et al. 2017

JAHA

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BackgroundIn cardiac resynchronization therapy (CRT), quadripolar (QUAD) left ventricular (LV) leads are less prone to postoperative complications than non‐QUAD leads. Some studies have suggested better clinical outcomes.Methods and ResultsClinical events were assessed in 847 patients after CRT‐pacing or CRT‐defibrillation using either QUAD (n=287) or non‐QUAD (n=560), programmed to single‐site site LV pacing. Over a follow‐up period of 3.2 years (median [interquartile range, 1.90–5.0]), QUAD was associated with a lower total mortality (adjusted hazard ratio [aHR]: 0.32, 95% confidence interval [CI], 0.20–0.52), cardiac mortality (aHR: 0.36, 95% CI, 0.20–0.65), and heart failure (HF) hospitalization (aHR: 0.62, 95% CI, 0.39–0.99), after adjustment for age, sex, New York Heart Association class, HF etiology, device type (CRT‐pacing or CRT‐defibrillation), comorbidities, atrial rhythm, medication, left ventricular ejection fraction, and creatinine. Death from pump failure was lower with QUAD (aHR: 0.33; 95% CI, 0.18–0.62), but no group differences emerged with respect to sudden cardiac death. There were no differences in implant‐related complications. Re‐interventions for LV displacement or phrenic nerve stimulation, which were lower with QUAD, predicted total mortality (aHR: 1.68, 95% CI, 1.11–2.54), cardiac mortality (aHR: 2.61, 95% CI, 1.66–4.11) and HF hospitalization (aHR: 2.09, 95% CI, 1.22–3.58).Conclusions CRT using QUAD, programmed to biventricular pacing with single‐site LV pacing, is associated with a lower total mortality, cardiac mortality, and HF hospitalization. These trends were observed for both CRT‐defibrillation and CRT‐pacing, after adjustment for HF cause and other confounders. Re‐intervention for LV lead displacement or phrenic nerve stimulation was associated with worse outcomes.

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Section: Discussionmentioning

confidence: 47%

Section: Lead Re-interventionsmentioning

confidence: 44%

mentioning

confidence: 99%

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Cardiac Resynchronization Therapy Using Quadripolar Versus Non‐Quadripolar Left Ventricular Leads Programmed to Biventricular Pacing With Single‐Site Left Ventricular Pacing: Impact on Survival and Heart Failure Hospitalization

Leyva

Zegard

Qiu

et al. 2017

JAHA

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“…The randomized MORE-CRT trial [12], [13] showed an increased procedural success and reduced intra- and post-operative complications with the use of quadripolar LV leads. Contrary to the results of previous work however, our study does not show a difference in mortality or rates of hospitalizations for heart failure or PNS in recipients of quadripolar versus bipolar LV leads [11], [14], [15].…”

Section: Discussionmentioning

confidence: 99%

Lead related complications in quadripolar versus bipolar left ventricular leads

Rijal

Wolfe

Rattan

et al. 2017

Indian Pacing and Electrophysiology Journal

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BackgroundQuadripolar left ventricular (LV) leads are capable of pacing from four different electrodes which allows for easier and more stable intra-operative lead positioning with optimal pacing parameters. We therefore investigated the rate of combined intra-operative and post-operative LV lead related events in quadripolar vs. bipolar LV lead cardiac resynchronization therapy (CRT) recipients in the real world setting.MethodsWe retrospectively collected data for N = 1441 patients at our institution implanted with quadripolar (n = 292) or bipolar (n = 1149) LV leads from 2012 to 2014 and followed them to the primary end-point of composite lead outcome defined as intra-operative lead implant failure or post-operative lead dislodgement or deactivations.ResultsPatients implanted with a quadripolar lead were younger (70.6 ± 11.4 vs 72.5 ± 11.6, p = 0.014) and had higher incidence of diabetes (41.8% vs 32.8%, p = 0.004) compared to those with bipolar leads. All other baseline characteristics were comparable. Patients implanted with a quadripolar were significantly less likely to reach the primary endpoint in the first 12 months after LV lead implantation (Hazard Ratio 0.22, 95% Confidence Interval 0.08–0.60, p = 0.001). There were no differences between the two groups in rates of hospitalization for any cause or in mortality.ConclusionIn this real world study, quadripolar LV leads have significantly lower rates of implantation failure and post-operative lead dislodgement or deactivation. These results have important clinical implications to CRT recipients.

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“…By using three-dimensional speckle tracking technique, researchers have found that multipole pacing (MPP) can reduce ventricular dyssynchrony index and increase ejection fraction [27]. A randomized controlled clinical trial has demonstrated that quadrupole electrodes can significantly reduce the perioperative complications and improve clinical outcomes [28]. However, the latest study reveals that optimization of the pacing site of a quadripolar LV lead is more important than to program MPP [29].…”

Section: Left Ventricular Electrode Implantationmentioning

confidence: 99%

Prevention of non-response to cardiac resynchronization therapy: points to remember

et al. 2019

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Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure. Non-response to CRT is one of the main obstacles to its application in clinical practice. There is no uniform consensus or definition of CRT "response." Clinical symptoms, ventricular remodeling indices, and cardiovascular events have been reported to be associated with nonresponders. To prevent non-response to CRT, three aspects should be thoroughly considered: preoperative patient selection, electrode implantation, and postoperative management. Preoperative selection of appropriate patients for CRT treatment is an important step in preventing non-response. Currently, the CRT inclusion criteria are mainly based on the morphology of QRS waves in deciding ventricular dyssynchrony. Echocardiography and cardiac magnetic resonance are being explored to predict nonresponse to CRT. The location of left ventricular electrode implantation is a current hot spot of research; it is important to identify the location of the latest exciting ventricular segment and avoid scars. Cardiac magnetic resonance and ultrasonic spot tracking are being progressively developed in this field. Some new techniques such as His Bundle pacing, endocardial electrodes, and novel sensors are also being investigated. Postoperative management of patients is another essential step towards preventing non-response; it mainly focuses on the treatment of the disease itself and CRT program control optimization. CRT treatment is just one part of the overall treatment of heart failure, and multidisciplinary efforts are needed to improve the overall outcome.

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Cardiac Resynchronization Therapy With a Quadripolar Electrode Lead Decreases Complications at 6 Months

Cited by 38 publications

References 24 publications

Cardiac Resynchronization Therapy Using Quadripolar Versus Non‐Quadripolar Left Ventricular Leads Programmed to Biventricular Pacing With Single‐Site Left Ventricular Pacing: Impact on Survival and Heart Failure Hospitalization

Cardiac Resynchronization Therapy Using Quadripolar Versus Non‐Quadripolar Left Ventricular Leads Programmed to Biventricular Pacing With Single‐Site Left Ventricular Pacing: Impact on Survival and Heart Failure Hospitalization

Lead related complications in quadripolar versus bipolar left ventricular leads

Prevention of non-response to cardiac resynchronization therapy: points to remember

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