Reduced Mortality Associated With Quadripolar Compared to Bipolar Left Ventricular Leads in Cardiac Resynchronization Therapy

Turakhia, Mintu P.; Cao, Michael; Fischer, Avi; Nabutovsky, Yelena; Sloman, L.; Dalal, Nirav; Gold, Michael R.

doi:10.1016/j.jacep.2016.02.007

Cited by 41 publications

(30 citation statements)

References 25 publications

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“…Outcomes following CRT implantation with quadripolar compared with bipolar leads have been reported from several previous studies with differing designs [8], [9], [10]. As with the current study from Rijal, in all previous reports, quadripolar leads were found to have a higher freedom from implant failure and/or need for early reintervention for dislodgment or PNS than bipolor leads.…”

supporting

confidence: 77%

“…additionally found that quadripolar CRT implants were associated with a lower rate of subsequent hospitalization – and therefore lower medical costs – than bipolar CRT implants [9]. Finally, a study including all U.S. patients from a single manufacturer's database including over 23,000 patients (roughly three-fourths treated with quadripolar leads) further reported that patients receiving quadripolar leads had slightly lower mortality (5.04 vs. 6.45 deaths per 100 patient-years, hazard ratio 0.77, p < 0.001) than those receiving bipolar leads [10].…”

mentioning

confidence: 99%

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For LV pacing, four is greater than two

Reynolds

Chaudhry

2017

Indian Pacing and Electrophysiology Journal

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supporting

confidence: 77%

mentioning

confidence: 99%

For LV pacing, four is greater than two

Reynolds

Chaudhry

2017

Indian Pacing and Electrophysiology Journal

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“…A recent retrospective study comparing QUAD with bipolar leads showed no difference in survival at 12 months (mean follow‐up 256 days for QUAD) . In contrast, a US‐wide study based on data from device implant records and telemonitoring showed that CRT‐D using QUAD was associated with a better survival than CRT‐D using bipolar leads . Observational data from 3 centers in the United Kingdom showed similar findings …”

Section: Discussionmentioning

confidence: 90%

“…Some observational studies have suggested that CRT‐D using QUAD programmed to single‐site LV pacing also improves survival . These findings, however, are not consistent, and there is uncertainty as to whether they also apply to CRT‐P.…”

Section: Introductionmentioning

confidence: 99%

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

Leyva

Zegard

Qiu

et al. 2017

JAHA

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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.

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“…Biventricular pacing, achieved by placing a left ventricular (LV) lead through a coronary venous branch in addition to a conventional RV lead, has been proven to prolong survival and improve symptoms and LV ejection fraction (EF) in patients with HF with widened QRS complexes (corresponding to ventricular depolarization) on the electrocardiogram (ECG) 44–46 . Given that approximately one-third of patients do not show improvements in functional capacity or EF with CRT, novel, multipoint pacing modalities have been developed 47 to pace the left ventricle at multiple points 48 . Randomized clinical trials to compare the effects of bipolar versus quadripolar leads in patients with CRT are ongoing 44 .…”

Section: Electronic Pacemakersmentioning

confidence: 99%

Next-generation pacemakers: from small devices to biological pacemakers

2017

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Electrogenesis in the heart begins in the sinoatrial node and proceeds down the conduction system to originate the heartbeat. Conduction system disorders lead to slow heart rates that are insufficient to support the circulation, necessitating implantation of electronic pacemakers. The typical electronic pacemaker consists of a subcutaneous generator and battery module attached to one or more endocardial leads. New leadless pacemakers can be implanted directly into the right ventricular apex, providing single-chamber pacing without a subcutaneous generator. Modern pacemakers are generally reliable, and their programmability provides options for different pacing modes tailored to specific clinical needs. Advances in device technology will probably include alternative energy sources and dual-chamber leadless pacing in the not-too-distant future. Although effective, current electronic devices have limitations related to lead or generator malfunction, lack of autonomic responsiveness, undesirable interactions with strong magnetic fields, and device-related infections. Biological pacemakers, generated by somatic gene transfer, cell fusion, or cell transplantation, provide an alternative to electronic devices. Somatic reprogramming strategies, which involve transfer of genes encoding transcription factors to transform working myocardium into a surrogate sinoatrial node, are furthest along in the translational pipeline. Even as electronic pacemakers become smaller and less invasive, biological pacemakers might expand the therapeutic armamentarium for conduction system disorders.

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Reduced Mortality Associated With Quadripolar Compared to Bipolar Left Ventricular Leads in Cardiac Resynchronization Therapy

Abstract: In this observational study of CRT-D devices, use of a quadripolar, compared to a bipolar LV lead, was associated with a reduction in LV lead deactivation, replacement, and mortality.

Cited by 41 publications

References 25 publications

For LV pacing, four is greater than two

For LV pacing, four is greater than two

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

Next-generation pacemakers: from small devices to biological pacemakers

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