The new Accutrak delivery system was associated with less deep prosthesis implantation in the left ventricular outflow tract, which could be related to the lower rate of permanent pacemaker requirement.

Purpose: The QUARTO II study was an observational study that investigated the response to Cardiac Resynchronization Therapy (CRT) with the Quartetw Left Ventricular (LV) quadripolar lead. This sub-analysis evaluated the mortality and all-cause hospitalization (hosp) rate in patients programmed using the proximal pair of electrodes of this quadripolar lead (non-conventional vectors) versus the conventional bipolar vectors in real clinical practice. Methods: Patients !18 years underwent CRT Defibrillator device implantation with a Quartetw lead (St Jude Medical) and were programmed as per the investigators' criteria. Study data were collected at baseline and 6 months post-implant. CRT response was defined a priori as a reduction in Left Ventricular End Systolic Volume (LVESV) of .15% at 6 months post-implant. Summary of results: A total of 198 patients were enrolled in the study across 26 sites in Spain and Portugal. There were 5 (4.2%) deaths, 38 (31.7%) all-cause hosp and 41 (34.2%) patients with the combined endpoint (death and all-cause hosp) in patients with conventional programming; and 1 (1.3%), 8 (10.4%) and 9 (11.7%), respectively, in the non-conv group. Echocardiographic data at 6 months was collected in 87 (72.5%) patients with conv pacing vector and 59 (76.6 %) with non-conventional. Purpose: Recently, novel quadripolar coronary sinus leads (Acuity X4 family) have been introduced for cardiac resynchronization therapy (CRT). These leads potentially allow to overcome issues related to high thresholds and phrenic nerve stimulation. Three models (with different shapes and inter-electrode spacing) are currently available: the spiral long (Spiral L), spiral short (Spiral S) and Straight. The performance of these leads after implantation has not yet been reported. Our aim was to evaluate the electrical parameters and requirements for repositioning at 3 months follow-up. Methods: First consecutive 201 patients with a standard indication for CRT enrolled in the RALLY-X4 study following successful implantation of an Acuity X4 lead for standard CRT indications were followed-up prospectively. The protocol of this post-market follow up registry with . 800 enrolments specified an initial mandated analysis of a 200 patient dataset collected after at least 3 months post implant.Results: A total of 201 patients (169 males, mean age 67.1 + 9.6 years) were followed-up for a mean of 6.9+ 4.5months. No dislodgements were observed which required repositioning. Only 1/201 (0.5%) patient required reintervention due to phrenic nerve stimulation which could not be resolved by reprogramming. The electrical parameters (at the programmed configuration) are shown in the table below. Values are shown as mean + SD apart from the capture thresholds which are expressed as median (interquartile range):Threshold (V; n 5 198) 1.0 (0.7-1.5) 0.9 (0.7-1.2) 1.1 (0.7-1.5) Sensing (mV; n 5 186)17. Purpose of the study: Cardiac resynchronization therapy (CRT) is an established therapy to reduce morbidity and mortality in heart failure patients. ...

A quadripolar lead offers multiple additional pacing options to increase CO acutely compared to conventional bipolar leads.

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