What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure requiring cardiac resynchronization therapy (n=721). Intervention: Quadripolar left ventricular (LV) leads vs. Bipolar left ventricular (LV) leads. Primary outcome: All-cause mortality (p=<0.001).

What question did this study set out to answer?

This research aims to evaluate the long-term outcomes of patients receiving quadripolar versus bipolar left ventricular leads in cardiac resynchronization therapy.

January 28, 2015Journal of Cardiovascular ElectrophysiologyOpen Access

Cardiac Resynchronization Therapy Delivered Via a Multipolar Left Ventricular Lead is Associated with Reduced Mortality and Elimination of Phrenic Nerve Stimulation: Long‐Term Follow‐Up from a Multicenter Registry

Q: What are the key findings of this study?

Quadripolar left ventricular leads for cardiac resynchronization therapy were associated with lower all-cause mortality compared to bipolar leads (13.2% vs. 22.5%, P<0.001) over 5 years.

Q: What question did this study set out to answer?

This research aims to evaluate the long-term outcomes of patients receiving quadripolar versus bipolar left ventricular leads in cardiac resynchronization therapy.

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Key result

Quadripolar left ventricular leads for cardiac resynchronization therapy were associated with lower all-cause mortality compared to bipolar leads (13.2% vs. 22.5%, P<0.001) over 5 years.

Why the study?

Does the use of quadripolar left ventricular leads compared to bipolar leads reduce mortality and improve lead performance in patients receiving cardiac resynchronization therapy?

Population

721 consecutive patients meeting conventional CRTD criteria, enrolled into a registry at 3 UK centers.

Comparison

Cardiac resynchronization therapy using… vs Cardiac resynchronization therapy using bipolar…

Design

Cohort

Follow-up

5 years

Authors

JBJonathan M. BeharElectrophysiology JBJulian BostockGuy's and St Thomas' NHS Foundation Trust ALAdrian Po Zhu LiKing's College Hospital NHS Foundation Trust

Discussion

Member takes

Implication

Supports quadripolar lead preference in CRT; hypothesis-generating and requires RCT validation.

Key Points

This research aims to evaluate the long-term outcomes of patients receiving quadripolar versus bipolar left ventricular leads in cardiac resynchronization therapy.
Analyzed data from 721 patients enrolled in a multicenter registry across 3 UK centers.
Compared performance and mortality of quadripolar (n=357) and bipolar leads (n=364) over a 5-year follow-up.
Investigated rates of phrenic nerve stimulation and lead displacement.
Patients with quadripolar leads experienced a lower all-cause mortality rate (13.2%) compared to those with bipolar leads (22.5%, P < 0.001).
Phrenic nerve stimulation was eliminated in all quadripolar lead cases where vector switching was applied, compared to 60% resolution in bipolar cases (P < 0.001).
Quadripolar leads showed significantly lower rates of lead displacement (1.7% vs. 4.6%, P = 0.03) and repositioning (2.0% vs. 5.2%, P = 0.03).

Study Design

Type

Cohort (n=721)

Multicenter

Yes

Structured PICO

Does the use of quadripolar left ventricular leads compared to bipolar leads reduce mortality and improve lead performance in patients receiving cardiac resynchronization therapy?

Population

721 consecutive patients meeting conventional CRTD criteria implanted with quadripolar or bipolar LV leads, followed over a 5-year period.

Exposure

Cardiac resynchronization therapy (CRT) using quadripolar left ventricular (LV) leads (n=357).

Comparator

Cardiac resynchronization therapy (CRT) using bipolar left ventricular (LV) leads (n=364).

Outcome

Lead performance (phrenic nerve stimulation, displacement, repositioning, threshold, impedance) and all-cause mortality over a 5-year period.hard clinical

Main Result

Absolute Event Rate: 13.2% vs 22.5%

p-value: p=<0.001

The use of quadripolar LV leads for CRT is associated with significantly lower long-term all-cause mortality and improved ability to eliminate phrenic nerve stimulation compared to bipolar leads.

Cite This Study

Behar et al. (2015) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=721). Quadripolar left ventricular (LV) leads vs. Bipolar left ventricular (LV) leads was evaluated on All-cause mortality (p=<0.001). Quadripolar left ventricular leads for cardiac resynchronization therapy were associated with lower all-cause mortality compared to bipolar leads (13.2% vs. 22.5%, P<0.001) over 5 years.

synapsesocial.com/papers/6a6af7b347a1bfb288f2fc2e https://doi.org/10.1111/jce.12625

Topics

Heart failure HFrEF treatment

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Cardiac Resynchronization Therapy Delivered Via a Multipolar Left Ventricular Lead is Associated with Reduced Mortality and Elimination of Phrenic Nerve Stimulation: Long‐Term Follow‐Up from a Multicenter Registry

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Cardiac Resynchronization Therapy Delivered Via a Multipolar Left Ventricular Lead is Associated with Reduced Mortality and Elimination of Phrenic Nerve Stimulation: Long‐Term Follow‐Up from a Multicenter Registry

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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Topics

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