The Use of Quadripolar Left Ventricular Leads Improves the Hemodynamic Response to Cardiac Resynchronization Therapy

Osca, Joaquín; Alonso, Pau; Cano, Óscar; Sánchez, Juan Miguel; Tejada, David; Andrés, Ana; Tello, M.J. Sancho; Olagüe, José

doi:10.1111/pace.12545

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…Initial experience has shown that CRT using quadripolar leads with an optimized left ventricular pacing configuration (LVPC) improved acute hemodynamics, synchrony, and also hospitalization rate. [ 5 , 6 ] Moreover, the method of improving the CRT response by multipoint left-ventricular pacing (MultiPoint Pacing [MPP]; St Jude Medical, Sylmar, CA), which recruits more left ventricular volume of myocardium at the same time based on LV quadripolar leads, has been confirmed by clinical practice. [ 7 ] Forleo et al have demonstrated that MPP improves clinical status and leads to an extra increase in LV ejection fraction (LVEF) compared with conventional CRT.…”

Section: Introductionmentioning

confidence: 99%

Repetitive optimizing left ventricular pacing configurations with quadripolar leads improves response to cardiac resynchronization therapy

Jin²,

Hua³

et al. 2017

Medicine

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Background:This study aimed to investigate whether repetitive optimizing left ventricular pacing configurations (LVPCs) with quadripolar leads (QUAD) can improve response to cardiac resynchronization therapy (CRT).Methods:Fifty-two eligible patients were enrolled and 1:1 randomized to either the quadripolar LV leads (QUAD) group or the conventional bipolar leads (CONV) group. In the QUAD group, optimization of LVPC was performed for all patients before discharge and for nonresponders at 3 months follow-up. Clinical evaluations and transthoracic echocardiograms were performed before, 3, and 6 months after CRT implantation.Results:At 3 months follow-up, 16 of 25 (64%) patients in the CONV group (1 patient was lost to follow-up) and 18 of 26 (69%) patients in the QUAD group were classified as responders. After optimizing the LVPCs in 3-month nonresponders in the QUAD group, 21 of 26 (80.8%) patients in the QUAD group were classified as responders at 6 months as compared with 17 of 25 (68%) patients in the CONV group. Left ventricular end-systolic volume (LVESV) reduction, left ventricular ejection fraction (LVEF) increase, and New York Heart Association (NYHA) functional class reduction at 6 months were significantly greater in the QUAD group than in the CONV group (LVESV: −26.9 ± 13.8 vs −17.2 ± 13.3%; P = .013; LVEF: +12.7 ± 8.0 vs +7.8 ± 6.3 percentage points; P = .017; NYHA: −1.27 ± 0.67 vs −0.72 ± 0.54 functional classes; P = .002).Conclusions:Compared with conventional bipolar leads, CRT using quadripolar leads with repetitive optimized LVPCs resulted in an additional increase in LVEF and reduction in LVESV and NYHA functional class at 6-month follow-up.

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Section: Introductionmentioning

confidence: 99%

Repetitive optimizing left ventricular pacing configurations with quadripolar leads improves response to cardiac resynchronization therapy

Jin²,

Hua³

et al. 2017

Medicine

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“…Since then, quadripolar leads have been introduced. While serving to address high pacing thresholds and phrenic nerve stimulation issues, the multiple pacing configurations can also result in better hemodynamic response than standard, distal biventricular stimulation . Using bioimpedance, Osca et al .…”

Section: Discussionmentioning

confidence: 99%

“…While serving to address high pacing thresholds and phrenic nerve stimulation issues, 16 the multiple pacing configurations can also result in better hemodynamic response than standard, distal biventricular stimulation. 9,17 Using bioimpedance, Osca et al 9 showed that the highest cardiac index was obtained by pacing from one of the two proximal electrodes, associated with AV and VV delay optimization, in 56% of patients. In their study, nine AV delays then seven VV delays were tested for each of the four electrodes, resulting in 64 settings tested, which is probably impractical in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

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Combination of the best pacing configuration and atrioventricular and interventricular delays optimization in cardiac resynchronization therapy

Socie

Squara

Semichon

et al. 2018

Pacing Clinical Electrophis

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“…Novel quadripolar LV leads offer 10 LV pacing configurations, and unipolar (extended bipolar) LV pacing is widely used to overcome technical issues such as phrenic nerve capture and stimulation thresholds. Using the best individual pacing configuration for each patient improves the hemodynamic response to CRT ( 7 - 9 ). Although the impact of LV pacing polarity on contractile functions has been investigated, little is known about the role of pacing polarity on repolarization patterns ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of the left ventricular pacing polarity and localization during cardiac resynchronization therapy on depolarization and repolarization parameters

Özcan

Öztürk²,

Özel

et al. 2018

Anatol J Cardiol

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Objective:Reversal of myocardial activation sequence during cardiac resynchronization therapy (CRT) may increase the transmural dispersion of repolarization (TDR), which may lead to ventricular arrhythmias. Quadripolar left ventricular (LV) leads offer 10 different pacing configurations. However, little is known about the role of pacing polarity on repolarization patterns. Our study aimed to investigate the impact of LV pacing polarity on depolarization and repolarization parameters in the same substrate in the same patient group.Methods:This study prospectively analyzed 20 patients who were consecutively admitted and underwent CRT-D implantation with quadripolar LV leads. Two bipolar pacing vectors and two unipolar vectors, also called extended bipolar pacing vectors, from the same pacing sites were selected for comparison. Electrocardiogram markers of depolarization and repolarization were measured and compared.Results:Bipolar LV pacing was associated with a significantly shorter QRS duration (basal, unipolar vs. bipolar, 135.1±17.8 vs. 119.3±14.5, p<0.01; non-basal, unipolar vs. bipolar, 134.4±15.7 vs. 121.9±10.3, p<0.01) and Tp-Te value (Basal, unipolar vs. bipolar, 119.1±36.7 vs. 97.6±27.9, p<0.05; non-basal, unipolar vs. bipolar, 117.9±36.3 vs. 98.6±20.4, p<0.05) than those in unipolar pacing. LV pacing from basal and non-basal segments had no differential effect on the repolarization parameters.Conclusion:The LV pacing polarity significantly affects QRS duration but not repolarization patterns regardless of the pacing site in the same substrate. From the perspective of basal and non-basal segments, the LV pacing site has no differential effect on the repolarization parameters.

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The Use of Quadripolar Left Ventricular Leads Improves the Hemodynamic Response to Cardiac Resynchronization Therapy

Abstract: The quadripolar LV lead was associated with a better hemodynamic response and higher CRT responder rates when compared with unipolar-simulated and bipolar LV leads.

Cited by 10 publications

References 28 publications

Repetitive optimizing left ventricular pacing configurations with quadripolar leads improves response to cardiac resynchronization therapy

Repetitive optimizing left ventricular pacing configurations with quadripolar leads improves response to cardiac resynchronization therapy

Combination of the best pacing configuration and atrioventricular and interventricular delays optimization in cardiac resynchronization therapy

The impact of the left ventricular pacing polarity and localization during cardiac resynchronization therapy on depolarization and repolarization parameters

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