Lead related complications in quadripolar versus bipolar left ventricular leads

Abstract

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.

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

“…A recent retrospective study comparing QUAD with bipolar leads showed no difference in survival at 12 months (mean follow-up 256 days for QUAD). 15 In contrast, a US-wide study based on data from device implant records and telemonitoring showed that CRT-D using QUAD was associated with a better survival than CRT-D using bipolar leads. 13 Observational data from 3 centers in the United Kingdom showed similar findings.…”

“…11,12 Some observational studies have suggested that CRT-D using QUAD programmed to single-site LV pacing also improves survival. [12][13][14] These findings, however, are not consistent, 15 and there is uncertainty as to whether they also apply to CRT-P. Moreover, the possible influence of HF etiology and the effects of QUAD on HF hospitalization and mode of death remain largely unexplored.…”

Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation

“…reported an overall 9% dislodgement rate with various LV lead types (bipolar, quadripolar, and active fixation leads), with a 4.8% rate for LV lead dislodgement required a re-operation. In 2017, a 2.1% vs. 3.0% dislodgement rate for quadripolar vs. bipolar CS leads was reported by Rijal et al 26 . Kassai et al 18 .…”

Multi-site multi-polar left ventricular pacing through persistent left superior vena cava in tricuspid valve disease

“…Quadripolar LV leads offer many extra pacing options than bipolar LV leads [23] , reducing the need for compromise among positional stability, phrenic nerve stimulation and capture threshold, and are associated with fewer complications [24] , [25] , [26] , [27] . In this case, the proximal 2 electrodes of the quadripolar lead in the MCV provided pacing while the distal 2 electrodes provided anchorage.…”