First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead

Sperzel, Johannes; Dänschel, Wilfried; Gutleben, Klaus; Kranig, Wolfgang; Mortensen, Peter Thomas; Connelly, Derek T.; Trappe, H.-J.; Seidl, Karlheinz; Duray, Gabor Z.; Pieske, Burkert; Stockinger, Jochem; Boriani, Giuseppe; Jung, Werner; Schilling, Richard J.; Saberi, Linda; Hallier, Benoit; Simon, Marcus; Rinaldi, Christopher Aldo

doi:10.1093/europace/eur322

Cited by 77 publications

(63 citation statements)

References 27 publications

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“…All of these prior studies reported a highly elevated implant success rate for the quadripolar leads, which varied between 95% [8] and 100% [5] of cases. The success rate of quadripolar lead implantation in the first selected vein in this work was greater than that reported in a previous study (85.7% vs. 78% [8]), which could be related to the larger number of patients with history of a previous device in this study (32% vs. 4.8%); some of these previous implantations included a failed conventional lead implant attempt.…”

Section: Previous Studiesmentioning

confidence: 99%

“…Outcomes using this quadripolar lead have only been reported in a few previous studies, two from the same group (initially with 28 patients [7] and later with 40 [8]), and another from multiple centers, including one where 71 patients were analyzed prospectively [8]. A fourth study represents the only other comparison of a group of 23 patients with bipolar leads to a group of 22 patients with quadripolar leads but included a follow-up period of only 3 months [5].…”

Section: Previous Studiesmentioning

confidence: 99%

“…1). The main goal of this multi-programmability is to decrease the need for surgical revisions and prevent the loss of CRT due to threshold or phrenic stimulation problems that cannot be non-invasively corrected [5][6][7][8]. The use of these leads could overcome the difficulties of successful implantation with conventional leads in some patients [9].…”

Section: Introductionmentioning

confidence: 99%

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Acute and mid-term outcomes of transvenous implant of a new left ventricular quadripolar lead versus bipolar leads for cardiac resynchronization therapy: Results from a single-center prospective database

Arias

Pachón²,

Puchol³

et al. 2012

Cardiol J

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Background: The purpose of this study was to evaluate the feasibility of the use of a quadripolar left ventricular (LV) lead for cardiac resynchronization therapy and to compare its acute and mid-term outcomes with those obtained with bipolar leads. Cardiac resynchronization exhibits a high incidence of problems involving the LV lead when conventional leads are used, and these problems may be minimized by using multipolar leads.

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Section: Previous Studiesmentioning

confidence: 99%

Section: Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute and mid-term outcomes of transvenous implant of a new left ventricular quadripolar lead versus bipolar leads for cardiac resynchronization therapy: Results from a single-center prospective database

Arias

Pachón²,

Puchol³

et al. 2012

Cardiol J

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“…In a recent study assessing the use of this quadripolar lead, 71 out of 75 patients underwent successful implantation of this lead [3]. The ability to identify a suitable pacing site within a branch of the CS increased from 86% (with a traditional true bipolar configuration) to 97% using 2 or more alternate configurations.…”

Section: Article P 470mentioning

confidence: 99%

More poles and more configurations: Seeking the Holy Grail for cardiac resynchronization therapy

Baranchuk

Somani²

2012

Cardiol J

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“…Quadripolar leads can be implanted distally in the coronary sinus (CS) branch by using a proximal electrode for pacing in a location with acceptable electrical parameters to avoid PNS. 6) However, quadripolar leads cannot escape from PNS when the phrenic nerve and CS branch are parallel and close. We report a case in whom we could avoid PNS by using short-spaced bipolar pacing.…”

mentioning

confidence: 99%

A Case of Useful Short-Spaced Bipolar Pacing of a Left Ventricular Lead to Avoid Phrenic Nerve Stimulation

et al. 2016

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SummaryA 48-year-old woman underwent cardiac resynchronization therapy defibrillator implantation. Coronary sinus (CS) venography showed only one adequate anterior branch for a left ventricular lead. We were able to introduce a quadripolar left ventricular lead to the distal portion of the anterior branch. Although phrenic nerve stimulation (PNS) occurred due to distal bipolar pacing (distal 1-mid 2, with 21-mm distance) and proximal pacing (mid 3-proximal 4, distance 21mm), short-spaced bipolar pacing (mid 2-3, distance 1.3 mm) did not induce PNS until 9V pacing. Shared bipolar pacing from each left ventricular electrode (distal 1 to proximal 4) as cathode and a right ventricular (RV) coil as anode resulted in PNS by 3.0V at 0.4 ms. Although quadripolar pacing could avoid PNS by switching the pacing site (ie, from distal bipolar to proximal bipolar), it might not avoid PNS in cases where the phrenic nerve and CS branch are parallel and in close proximity. We found that even though the phrenic nerve and CS branch were parallel and close, short-spaced bipolar pacing could avoid PNS. In conclusion, short-spaced bipolar pacing selected by quadripolar pacing might be beneficial to avoid PNS when the implantable branch is limited. (Int Heart J 2016; 57: 118-120) Key words: Cardiac resynchronization therapy, Interelectrode spacing H eart failure that is resistant to optimal medical therapy remains a major problem in cardiovascular medicine. 1,2) In cases of heart failure with cardiac dyssynchrony, 3,4) cardiac resynchronization therapy (CRT) is often used. Phrenic nerve stimulation (PNS) is a major problem in implantation of CRT. 5) A unipolar or bipolar lead might have to be implanted more proximally in a vein to avoid PNS and be at increased risk of dislodgement. Quadripolar leads can be implanted distally in the coronary sinus (CS) branch by using a proximal electrode for pacing in a location with acceptable electrical parameters to avoid PNS. 6) However, quadripolar leads cannot escape from PNS when the phrenic nerve and CS branch are parallel and close. We report a case in whom we could avoid PNS by using short-spaced bipolar pacing. Case ReportA 48-year-old woman was referred to our hospital due to syncope. Her electrocardiogram showed ventricular fibrillation, and her consciousness was recovered by two automated external defibrillator shocks. Left ventricular (LV) ejection fraction was 16% and QRS duration was 177 ms with left bundle branch block. She underwent CRT-defibrillator (CRT-D) implantation. After implantation of the right atrial lead and shock lead, CS venography was performed. The venography showed only one adequate anterior branch to introduce LV lead (Figure 1), and we planned to introduce an LV lead to the branch. We could introduce an LV lead (Medtronic 4398-88 cm) to the distal edge of the anterior branch, and tested the pacing threshold and PNS threshold (Figure 2).Although PNS occurred by distal bipolar pacing (distal 1-mid 2) and proximal pacing (mid 3-proximal 4) (5.0V at 0.4 ms, and th...

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First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead

Cited by 77 publications

References 27 publications

Acute and mid-term outcomes of transvenous implant of a new left ventricular quadripolar lead versus bipolar leads for cardiac resynchronization therapy: Results from a single-center prospective database

Acute and mid-term outcomes of transvenous implant of a new left ventricular quadripolar lead versus bipolar leads for cardiac resynchronization therapy: Results from a single-center prospective database

More poles and more configurations: Seeking the Holy Grail for cardiac resynchronization therapy

A Case of Useful Short-Spaced Bipolar Pacing of a Left Ventricular Lead to Avoid Phrenic Nerve Stimulation

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