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

Abstract

BackgroundIn cardiac resynchronization therapy (CRT), quadripolar (QUAD) left ventricular (LV) leads are less prone to postoperative complications than non‐QUAD leads. Some studies have suggested better clinical outcomes.Methods and ResultsClinical events were assessed in 847 patients after CRT‐pacing or CRT‐defibrillation using either QUAD (n=287) or non‐QUAD (n=560), programmed to single‐site site LV pacing. Over a follow‐up period of 3.2 years (median [interquartile range, 1.90–5.0]), QUAD was associated with a lower total mortality (adjusted hazard ratio [aHR]: 0.32, 95% confidence interval [CI], 0.20–0.52), cardiac mortality (aHR: 0.36, 95% CI, 0.20–0.65), and heart failure (HF) hospitalization (aHR: 0.62, 95% CI, 0.39–0.99), after adjustment for age, sex, New York Heart Association class, HF etiology, device type (CRT‐pacing or CRT‐defibrillation), comorbidities, atrial rhythm, medication, left ventricular ejection fraction, and creatinine. Death from pump failure was lower with QUAD (aHR: 0.33; 95% CI, 0.18–0.62), but no group differences emerged with respect to sudden cardiac death. There were no differences in implant‐related complications. Re‐interventions for LV displacement or phrenic nerve stimulation, which were lower with QUAD, predicted total mortality (aHR: 1.68, 95% CI, 1.11–2.54), cardiac mortality (aHR: 2.61, 95% CI, 1.66–4.11) and HF hospitalization (aHR: 2.09, 95% CI, 1.22–3.58).Conclusions CRT using QUAD, programmed to biventricular pacing with single‐site LV pacing, is associated with a lower total mortality, cardiac mortality, and HF hospitalization. These trends were observed for both CRT‐defibrillation and CRT‐pacing, after adjustment for HF cause and other confounders. Re‐intervention for LV lead displacement or phrenic nerve stimulation was associated with worse outcomes.

Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response

“…We sought to assess whether scar quantification by CMR is independently and incrementally predictive heart failure hospitalisation and death after CRT implantation when accounting for clinical data, the presence of LBBB and QRSd, and LV lead tip position in relation to scar19 and lead polarity 20 21…”

Catheter ablation of atrial fibrillation—A key role in heart failure therapy?

“…In addition to catheter ablation of AF, adjuvant therapies may also be considered. Recent advances in the field of cardiac resynchronization therapy like multipolar pacing have shown promising results reducing cardiac mortality, hospitalization rate, and AF burden …”

“…Recent advances in the field of cardiac resynchronization therapy like multipolar pacing have shown promising results reducing cardiac mortality, hospitalization rate, and AF burden. 46,47 In addition, catheter ablation results might be improved by novel therapies. Selectively targeting microRNAs might influence cardiac electrical and fibrotic remodeling after AF ablation.…”

Effect of lead design and pacing vector on electrical parameters of quadripolar coronary sinus leads: The RALLY‐X4 study

“…A meta‐analysis of eight studies and a report with a large real‐world experience have shown that quadripolar leads have lower rates of implantation failure, postoperative lead dislodgement, revision, or deactivation. Clinical outcome in terms of mortality and heart failure hospitalization has also been shown to be reduced with quadripolar leads compared to bipolar leads in a nonrandomized but matched population . Manufacturers propose quadripolar leads of different diameters, shapes, and interlead spacing to address variations in coronary sinus (CS) tributary anatomy.…”