What question did this study set out to answer?

To evaluate the clinical performance of a quadripolar lead and compare its long-term clinical outcomes against bipolar leads for left ventricular pacing in cardiac resynchronization therapy.

May 16, 2018Indian Heart JournalOpen Access

Performance and clinical comparison between left ventricular quadripolar and bipolar leads in cardiac resynchronization therapy: Observational research

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure requiring cardiac resynchronization therapy (n=336). Intervention: Quadripolar lead (Attain Performa) vs. Bipolar leads. Primary outcome: Long-term clinical outcomes (heart failure worsening, ventricular arrhythmias, pulmonary congestion).

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Key result

Quadripolar leads provided pacing configurations unavailable with bipolar leads in 50% of patients, and showed a trend toward lower incidence of ventricular arrhythmias and pulmonary congestion.

Why the study?

Does a left ventricular quadripolar lead improve lead performance and clinical outcomes compared to a bipolar lead in patients undergoing cardiac resynchronization therapy?

Population

336 patients undergoing cardiac resynchronization therapy

Comparison

Left ventricular quadripolar lead vs Left ventricular bipolar lead

Design

Cohort

Follow-up

median 14 months

Authors

MZMatteo ZiacchiElectrophysiology GZGiulio ZucchelliElectrophysiology DRDanilo RicciardiUniversità Campus Bio-Medico

Discussion

Member takes

Implication

Supports quadripolar lead targeting in CRT; hypothesis-generating for reduced HF worsening and arrhythmias, pending RCTs.

Key Points

To evaluate the clinical performance of a quadripolar lead and compare its long-term clinical outcomes against bipolar leads for left ventricular pacing in cardiac resynchronization therapy.
Retrospectively analyzed procedural and follow-up data from 215 patients implanted with an Attain Performa quadripolar lead.
Compared long-term clinical outcomes against a cohort of 121 patients implanted with bipolar leads over a median follow-up of 14 months.
Quadripolar leads were successfully placed in target veins in 91% (196/215) of patients without acute dislodgements, with 50% utilizing pacing configurations unavailable with bipolar leads.
Dedicated quadripolar pacing vectors were chosen significantly more often when the left ventricular lead tip was in an apical position compared to non-apical positions (65.6% vs 42.7%, p=0.003).
At 14 months, 90% (98 patients) maintained an LV pacing threshold <2.5V at 0.4ms and 89% (97 patients) had a phrenic nerve safety margin >3V, alongside trends toward reduced ventricular arrhythmias and pulmonary congestion.

Study Design

Type

Observational (n=336)

Structured PICO

Does a left ventricular quadripolar lead improve lead performance and clinical outcomes compared to a bipolar lead in patients undergoing cardiac resynchronization therapy?

Population

336 patients implanted with a quadripolar (n=215) or bipolar (n=121) lead for left ventricular pacing, followed for a median of 14 months.

Exposure

Left ventricular quadripolar lead (Attain Performa)

Comparator

Left ventricular bipolar lead

Outcome

Lead performance (acute dislodgements, pacing configuration, pacing threshold, safety margin) and long-term clinical outcomes (heart failure worsening, ventricular arrhythmias, pulmonary congestion)surrogate

Quadripolar LV leads in CRT offer improved pacing configurations and management of phrenic nerve stimulation without compromising pacing thresholds, potentially reducing ventricular arrhythmias and HF worsening compared to bipolar leads.

Limitations

Retrospective design
Further investigations are necessary to confirm that the positive effect is associated with better LV reverse remodeling
Further investigations necessary to confirm positive effect on LV reverse remodeling

Cite This Study

Ziacchi et al. (2018) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=336). Quadripolar lead (Attain Performa) vs. Bipolar leads was evaluated on Long-term clinical outcomes (heart failure worsening, ventricular arrhythmias, pulmonary congestion). Quadripolar leads provided pacing configurations unavailable with bipolar leads in 50% of patients, and showed a trend toward lower incidence of ventricular arrhythmias and pulmonary congestion.

synapsesocial.com/papers/6a93bf369694293cf3453aac https://doi.org/10.1016/j.ihj.2018.05.007

Topics

Heart failure HFrEF treatment

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Performance and clinical comparison between left ventricular quadripolar and bipolar leads in cardiac resynchronization therapy: Observational research

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Performance and clinical comparison between left ventricular quadripolar and bipolar leads in cardiac resynchronization therapy: Observational research

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider