November 4, 2014EP Europace
Hospitalization rates and associated cost analysis of cardiac resynchronization therapy with an implantable defibrillator and quadripolar vs. bipolar left ventricular leads: a comparative effectiveness study
Key result
Quadripolar left ventricular leads in CRT-D patients were associated with lower rates of hospitalization for heart failure or lead revision compared to bipolar leads (IRR 0.46; P=0.04).
Why the study?
Does a quadripolar LV lead reduce post-implant hospitalizations and costs compared to a bipolar LV lead in patients receiving de novo CRT-D implants?
Population
193 consecutive patients receiving de novo cardiac resynchronization therapy-defibrillator implants at a…
Comparison
Quadripolar (QUAD) left ventricular (LV) lead vs Bipolar (BIP) left ventricular (LV) lead
Design
Cohort
Follow-up
Enrolled between January 2009 and December 2012, followed…
Authors
Discussion
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Member takes
Implication
Should not yet change CRT-D lead selection; leaves open need for randomized confirmation of benefit.
Study Design
Type
Observational (n=193)
Multicenter
No
Structured PICO
Does a quadripolar LV lead reduce post-implant hospitalizations and costs compared to a bipolar LV lead in patients receiving de novo CRT-D implants?
P
Population
193 consecutive patients receiving de novo CRT-D implants with either a quadripolar or bipolar left ventricular lead (analyzed as a 154-patient propensity-matched cohort), followed at a single center.
E
Exposure
Quadripolar (QUAD) left ventricular (LV) lead
C
Comparator
Bipolar (BIP) left ventricular (LV) lead
O
Outcome
Post-implant hospitalization rates related to heart failure (HF) or LV lead surgical revision and associated payer costscomposite
Main Result
Relative Risk: 0.46
Absolute Event Rate: 0.15% vs 0.32%
p-value: p=0.04
Quadripolar LV leads for CRT-D are associated with significantly lower rates of HF or lead revision hospitalizations and reduced healthcare costs compared to bipolar leads.
Cite This Study
Forleo et al. (2014) conducted an observational in Heart failure requiring CRT-D (n=193). Quadripolar (QUAD) left ventricular lead vs. Bipolar (BIP) left ventricular lead was evaluated on Post-implant hospitalizations related to heart failure (HF) or LV lead surgical revision (IRR 0.46, p=0.04). Quadripolar left ventricular leads in CRT-D patients were associated with lower rates of hospitalization for heart failure or lead revision compared to bipolar leads (IRR 0.46; P=0.04).