Performance of a novel left ventricular lead with short bipolar spacing for cardiac resynchronization therapy: Primary results of the Attain Performa Quadripolar Left Ventricular Lead Study

Crossley, George H.; Biffi, Mauro; Johnson, Ben; Lin, Albert; Gras, Daniel; Hussin, Azlan; Cuffio, Allen; Collier, Jack; El‐Chami, Mikhael F.; Li, Shelby; Holloman, Keith; Exner, Derek V.

doi:10.1016/j.hrthm.2014.12.019

Cited by 45 publications

(65 citation statements)

References 36 publications

(47 reference statements)

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“…It is worth noting however that our study was based exclusively on our institutional records, independent of data sponsored by industry. In addition, our study is the first to look at the combined performance of quadripolar leads from two manufacturers as all prior studies focused on one lead model from a single manufacturer [13], [16]. Lastly, our study has included LV leads implanted with CRT-D and CRT-P devices, unlike all other similar studies that focused exclusively on CRT-D recipients.…”

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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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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“…The lack of improvement is multi-faceted, owing both to pts selection and technical CRT issues. Phrenic nerve stimulation (PNS), high myocardial threshold (HMT), left ventricular lead dislodgement (LD) and failure to achieve the target pacing site are the most frequent technical issues 1,2 , that were aimed at by the introduction of new left ventricular leads such as the quadripolar (QL) and the bipolar active fixation leads (AFL) 3–6 . This is the first study comparing 3 different LV lead platforms for CRT with defibrillator: bipolar passive fixation lead (BL), QL and AFL.…”

Section: Introductionmentioning

confidence: 99%

Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

Ziacchi

Diemberger

Corzani

et al. 2018

Sci Rep

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We evaluated the performance of 3 different left ventricular leads (LV) for resynchronization therapy: bipolar (BL), quadripolar (QL) and active fixation leads (AFL). We enrolled 290 consecutive CRTD candidates implanted with BL (n = 136) or QL (n = 97) or AFL (n = 57). Over a minimum 10 months follow-up, we assessed: (a) composite technical endpoint (TE) (phrenic nerve stimulation at 8 V@0.4 ms, safety margin between myocardial and phrenic threshold <2V, LV dislodgement and failure to achieve the target pacing site), (b) composite clinical endpoint (CE) (death, hospitalization for heart failure, heart transplantation, lead extraction for infection), (c) reverse remodeling (RR) (reduction of end systolic volume >15%). Baseline characteristics of the 3 groups were similar. At follow-up the incidence of TE was 36.3%, 14.3% and 19.9% in BL, AFL and QL, respectively (p < 0.01). Moreover, the incidence of RR was 56%, 64% and 68% in BL, AFL and QL respectively (p = 0.02). There were no significant differences in CE (p = 0.380). On a multivariable analysis, “non-BL leads” was the single predictor of an improved clinical outcome. QL and AFL are superior to conventional BL by enhancing pacing of the target site: AFL through prevention of lead dislodgement while QL through improved management of phrenic nerve stimulation.

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“…The 2 major advantages of quadripolar LV pacing leads are (1) they offer a greater opportunity to pace from a nonapical pacing electrode and (2) they mitigate the need for reoperation to manage complications because of the greater number of programming vectors available. However, the pacing capture threshold (PCT) of currently available LV leads increases when pacing from more proximal electrodes, and result in low utilization . Therefore, a new family of quadripolar LV leads was designed to ensure low PCTs from nonapical regions of the LV, while maintaining a high degree of stability and programming options to manage phrenic nerve stimulation (PNS).…”

Section: Introductionmentioning

confidence: 99%