Effects of implantation of quadripolar left ventricular leads on CRT response

Erath, Julia W.; Vámos, Máté; Domokos, Dominika; Benz, Alexander P; Bári, Zsolt; Bogyi, Peter; Duray, Gabor Z.; Hohnloser, Stefan H.

doi:10.1007/s10840-019-00545-8

Cited by 9 publications

(15 citation statements)

References 19 publications

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“…QRS shortening was also more in the Quad group (Δ 12.56 ± 3.11 vs Δ 7.29 ± 1.87 ms in BiP; p 0.04) which was in line with the study done by Earth et al. (2019) [ 20 ] (Δ-21 ms in Quad vs Δ-8 in BiP; p < 0.001).…”

Section: Discussionsupporting

confidence: 90%

“…Electronic repositioning due to multiple poles in the quadripolar lead is an easy answer to high thresholds and PNS in the Quad group. The bipolar lead had a significantly higher impedance at implant and 6 months in our study, which has been shown in independent studies, that increased LV lead impedance and the threshold are contributory to chances of LV lead deactivation or revision procedures in follow up [ 20 , 34 ].…”

Section: Discussionsupporting

confidence: 82%

“…(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). 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).…”

Section: Discussionmentioning

confidence: 99%

“…(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%

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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: 90%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…In recent years, the development of quadripolar LV lead technology has been probably the most important improvement in CRT therapy, by enabling a reduction of short-term lead-related complications 11 coupled with improved clinical outcomes. [12][13][14][15] The quadripolar lead design gives the option of multiple pacing vectors, thereby allowing to deliver pacing more frequently to the target LV area while reducing the impact of PNS. Moreover, recent studies suggest that the use of quadripolar lead reduces mortality over 2-3 years compared to a bipolar lead, [12][13][14][15][16] likely thanks to the increased programming options that reduce the need for reintervention or turning off the LV stimulation.…”

Section: Discussionmentioning

confidence: 99%

Long‐term follow‐up of patients with a quadripolar active fixation left ventricular lead: An Italian multicenter experience

Regibus

Biffi

Infusino

et al. 2022

Cardiovasc electrophysiol

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Introduction: Left ventricular (LV) lead optimal positioning is one of the most important determinants of cardiac resynchronization therapy (CRT) success. LV quadripolar active fixation (QAF) leads have been designed to ensure stable LV pacing in the target area and reduce the likelihood of phrenic nerve stimulation (PNS). The aim of this analysis is to compare performances, safety, and clinical outcomes of QAF with those of quadripolar passive fixation leads (QPL) and bipolar active fixation (BAF) leads in a real-world cohort of CRT patients. Methods and Results: This retrospective analysis compared the procedure and follow-up data of 117 QAF included in the One Hospital ClinicalService project from nine Italian hospitals with two historical cohorts of 261 BAF and 124 QPL. QAF enabled basal pacing more frequently than QPL (24.1% vs. 6.5%, p < .001) but not differently from BAF (p = .981). At implant, mean QAF LV myocardial threshold (LVMT) was 1.21 ± 0.8 V at 0.4 ms, not different from that of BAF (p = .346) and QPL (p = .333). At a median follow-up of 22 months, LVMT was 1.37 ± 0.90 V (p = .036 vs.

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Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

et al. 2022

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Cardiac resynchronization therapy (CRT) may improve not only impaired left ventricular contractility but can also induce reverse remodeling of native conduction system. Measurement of intrinsic QRS complex width during follow-up is the simplest method to assess reverse electrical remodeling (RER). We aimed to provide a literature review and meta-analysis on incidence and impact of RER and its association with mechanical remodeling. A systematic review and random-effect meta-analysis of studies reporting data on RER was performed. A total of 16 studies were included in this meta-analysis with 930 patients undergoing CRT (mean age 64.0 years, 64.1% males). The weighted mean incidence of RER was 42%. Reverse mechanical remodeling assessed by echocardiography was more frequently observed in patients with RER compared to patients without RER (75.7% vs. 46.6%; odds ratio [OR] 3.7, 95% confidence interval [CI] 2.24-6.09, p < 0.01). Mechanical responders had a mean iQRS shortening of 7.7 ms, while mechanical non-responders experienced a mean widening of iQRS by 5.2 ms (p < 0.01). Clinical improvement was more frequent in patients with RER vs. patients without RER (82.9% vs. 49.0%; OR 5.26; 95% CI 2.92-9.48; p < 0.01). No significant difference in all-cause mortality between patients with and without RER was found. Mean difference between baseline intrinsic QRS and post-implantation paced QRS was significant in patients with later RER (21.2 ms, 95% CI 9.4-32.9, p < 0.01), but not in patients without RER (6.6 ms, 95% CI -2.2-15.4, p = 0.14). Gender, initial left bundle block morphology and heart failure etiology were found not to be predictive for RER. Our meta-analysis demonstrates that shortening of iQRS duration is a common finding during follow-up of patients undergoing CRT and is associated with mechanical reverse remodeling and clinical improvement. Clinical Trial Registration: Prospero Database-CRD42021253336.

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Effects of implantation of quadripolar left ventricular leads on CRT response

Cited by 9 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

Long‐term follow‐up of patients with a quadripolar active fixation left ventricular lead: An Italian multicenter experience

Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

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