Outcomes of cardiac resynchronization therapy using left ventricular quadripolar leads

Yang, Mei; Li, Xuping; Liang, Jinjun; Asirvatham, Samuel J.; Espinosa, Raúl E.; Li, Yi‐Gang; Friedman, Paul A.; Mei, Yong

doi:10.1111/pace.13388

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…NYHA class improvement was more with quadripolar lead at six months, and this was in concordance with previous studies by Yang et al. (2018) [ 6 ] (62.9 Quad vs 51.4 BiP; p 0.04) and Earth et al. (2019) [ 20 ] (QP LV leads (OR = 2.30; 95% CI 1.37–3.85; p 0.002).…”

Section: Discussionsupporting

confidence: 91%

“…(2019) [ 20 ] (QP LV leads (OR = 2.30; 95% CI 1.37–3.85; p 0.002). Taking ≥1 NHYA class improvement as a criterion of response [ 6 , 7 , 12 , 20 ] CRT responder at six months were more in the quadripolar group (87.09% vs 67.74% in BiP; p 0.04). Greater NYHA improvement can be attributed to better LVEF improvement at six months (Δ9.39 ± 1.48% in Quad vs Δ 5.61 ± 1.05% in BiP; p 0.004) and extensive use of diuretics (100% in both the study groups) which was higher when compared to diuretic use in MIRACLE (91%) [ 11 ], RAFT (84.7%) [ 13 ] and MADIT CRT (75.7%) [ 17 ] trials.…”

Section: Discussionmentioning

confidence: 99%

“…Fig. 1 shows the study design, and the outcome were compared in five variables; the CRT response rate (defined as ≥5% absolute increase in LV ejection fraction from baseline) [ [6] , [7] , [8] , [9] ], NYHA functional class improvement, all-cause mortality, HF hospitalization events (defined as hospitalization for ≥24 h or any admission requiring intravenous administration of inotropes, diuretics or vasodilators) and LV lead-related complications. All patients admitted during the follow up of the study received guideline-directed medical therapy (GDMT).…”

Section: Methodsmentioning

confidence: 99%

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Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

Raj

Singh

Nath

et al. 2021

Indian Pacing and Electrophysiology Journal

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Background and objectives Quadripolar left ventricular (LV) leads in cardiac resynchronization therapy (CRT) offer multi-vector pacing with different pacing configurations and hence enabling LV pacing at most suitable site with better lead stability. We aim to compare the outcomes between quadripolar and bipolar LV lead in patients receiving CRT. Methods In this prospective, non-randomized, single-center observational study, we enrolled 93 patients receiving CRT with bipolar (BiP) (n = 31) and quadripolar (Quad) (n = 62) LV lead between August 2016 to August 2019. Patients were followed for six months, and outcomes were compared with respect to CRT response (defined as ≥5% absolute increase in left ventricle ejection fraction), electrocardiographic, echocardiographic parameters, NYHA functional class improvement, and incidence of LV lead-related complication. Results At the end of six months follow up, CRT with quadripolar lead was associated with better response rate as compared to bipolar pacing (85.48% vs 64.51%; p = 0.03), lesser heart failure (HF) hospitalization events (1.5 vs 2; p = 0.04) and better improvement in HF symptoms (patients with ≥1 NYHA improvement 87.09% vs 67.74%; p = 0.04). There were fewer deaths per 100 patient-year (6.45 vs 9.37; p = 0.04) and more narrowing of QRS duration (Δ12.56 ± 3.11 ms vs Δ7.29 ± 1.87 ms; p = 0.04) with quadripolar lead use. Lead related complications were significantly more with the use of bipolar lead (74.19% vs 41.94%; p = 0.02). Conclusions Our prospective, non-randomized, single-center observational study reveals that patients receiving CRT with quadripolar leads have a better response to therapy, lesser heart failure hospitalizations, lower all-cause mortality, and fewer lead-related complications, proving its superiority over the bipolar lead.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

Raj

Singh

Nath

et al. 2021

Indian Pacing and Electrophysiology Journal

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“…However, prospective randomized clinical trials assessing the mortality rates with IS‐4 and IS‐1 systems with long‐term FU are lacking and may suffer from confounding effects due to concomitant heart failure therapy regimen changes over time. One randomized controlled trial with a 6‐month FU time 10 and other studies with up to 12 months of FU time showed no significant difference in all‐cause mortality rate 9,11,20–24 . Interestingly, other retrospective studies with long‐term FU (>3 years) or large patient groups showed lower mortality for patients implanted with IS‐4 LV leads 12–13,25 .…”

Section: Discussionmentioning

confidence: 98%

“…One randomized controlled trial with a 6-month FU time 10 and other studies with up to 12 months of FU time showed no significant difference in all-cause mortality rate. 9,11,[20][21][22][23][24] Interestingly, other retrospective studies with long-term FU (>3 years) or large patient groups showed lower mortality for patients implanted with IS-4 LV leads. [12][13]25 By contrast, the all-cause mortality rate of the IS-4 and the IS-1 patient group did not show significant difference at a minimum of 3 years FU in our cohort.…”

Section: Mortalitymentioning

confidence: 91%

Acute and long‐term outcomes of quadripolar IS‐4 versus bipolar IS‐1 left ventricular leads in cardiac resynchronization therapy: A retrospective registry study

Maurhofer

Asatryan

Haeberlin

et al. 2023

Pacing Clinical Electrophis

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Background:The implantation procedure of left ventricular (LV) leads and the management of cardiac resynchronization therapy (CRT) patients can be challenging. The IS-4 standard for CRT offers additional pacing vectors compared to bipolar leads (IS-1). IS-4 leads improve procedural outcome and may also result in lower adverse events during follow-up (FU) and improve clinical outcome in CRT patients. Further long-term FU data comparing the two lead designs are necessary. Methods:In this retrospective, single-center study we included adult patients implanted with a CRT-Defibrillator (CRT-D) or CRT-Pacemaker (CRT-P) with a quadripolar (IS-4 group) or bipolar (IS-1 group) LV lead and with available ≥3 years clinical FU. The combined primary endpoint was a combination of predefined, lead-related adverse events. Secondary endpoints were all single components of the primary endpoint.Results: Overall, 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03 ± 1.93 years were included. Lead-related adverse events were less frequent in patients with an IS-4 lead than with an IS-1 lead (n = 8, 12.1% vs. n = 23, 34.3%; p = .002).The secondary outcomes showed a lower rate of LV lead deactivation/explantation and LV lead dislodgement/dysfunction (4.5% vs. 22.4%; p = .003; 4.5% vs. 17.9%; p = .015, respectively) in the IS-4 patient group. Less patients suffered from unresolved phrenic nerve stimulation with an IS-4 lead (3.0% vs. 13.4%; p = .029). LV lead-related re-interventions were fewer in case of an IS-4 lead (6.1% vs. 17.9%; p = .036). Conclusion:In this retrospective analysis, the IS-4 LV lead is associated with lower lead-related complication rates than the IS-1 lead at long-term FU.

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Current developments in cardiac rhythm management devices

et al. 2018

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Endocardial pacing has experienced a tremendous evolution since the 1960s. A lot of challenges associated with pacemaker and ICD devices have already been successfully targeted. However, a relevant number of problems have not been solved to date. Not all patients with accepted indication for biventricular pacing have benefited from cardiac resynchronisation therapy (CRT) despite extensive efforts to reduce the rate of non-responders. Current strategies to optimize lead position, multipolar left-ventricular (LV) pacing leads, new strategies to gain access to the left-ventricle (atrial transseptal or ventricular transseptal access) or alternative right-ventricular (septal, His bundle pacing) pacing sites, and "leadless" LV pacing have the potential to increase response to device-based heart-failure treatment. The opportunity of pacemaker and ICD remote monitoring led to relevant improvements in therapy management by timely detection of events requiring medical or invasive interventions (e.g., external cardioversion of atrial fibrillation, increasing effective biventricular pacing, catheter ablation of ventricular tachycardias, or changes in heart-failure medication). Two completely endocardial leadless "all-in-one" pacemaker systems recently became available. Besides these innovations, new "synergistic" therapy concepts combining catheter ablation and device therapy proved to affect clinical endpoints (e.g., ATAAC study and CASTLE-AF study).

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Outcomes of cardiac resynchronization therapy using left ventricular quadripolar leads

Abstract: Quadripolar leads achieve similar CRT outcomes as bipolar LV leads but with a higher implant success rate and fewer procedure-related complications.

Cited by 7 publications

References 19 publications

Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

Acute and long‐term outcomes of quadripolar IS‐4 versus bipolar IS‐1 left ventricular leads in cardiac resynchronization therapy: A retrospective registry study

Current developments in cardiac rhythm management devices

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