Key result
Quadripolar left ventricular leads were associated with a significantly lower risk of implant failure, dislodgement, or deactivation than bipolar leads (HR 0.22; 95% CI 0.08-0.60; p=0.001).
Why the study?
Does the use of quadripolar LV leads reduce intra-operative and post-operative lead-related complications compared to bipolar LV leads in CRT recipients?
Cohort (n=1,441)
No
Does the use of quadripolar LV leads reduce intra-operative and post-operative lead-related complications compared to bipolar LV leads in CRT recipients?
Hazard Ratio: 0.22 (95% CI 0.08–0.6)
p-value: p=0.001
Quadripolar LV leads significantly reduce the risk of intra-operative implant failure and post-operative dislodgement or deactivation compared to bipolar leads in CRT recipients.
Quadripolar leads linked to fewer LV lead events in CRT; observational data leaves open need for randomized confirmation.
BACKGROUND: Quadripolar left ventricular (LV) leads are capable of pacing from four different electrodes which allows for easier and more stable intra-operative lead positioning with optimal pacing parameters. We therefore investigated the rate of combined intra-operative and post-operative LV lead related events in quadripolar vs. bipolar LV lead cardiac resynchronization therapy (CRT) recipients in the real world setting. METHODS: We retrospectively collected data for N = 1441 patients at our institution implanted with quadripolar (n = 292) or bipolar (n = 1149) LV leads from 2012 to 2014 and followed them to the primary end-point of composite lead outcome defined as intra-operative lead implant failure or post-operative lead dislodgement or deactivations. RESULTS: Patients implanted with a quadripolar lead were younger (70.6 ± 11.4 vs 72.5 ± 11.6, p = 0.014) and had higher incidence of diabetes (41.8% vs 32.8%, p = 0.004) compared to those with bipolar leads. All other baseline characteristics were comparable. Patients implanted with a quadripolar were significantly less likely to reach the primary endpoint in the first 12 months after LV lead implantation (Hazard Ratio 0.22, 95% Confidence Interval 0.08-0.60, p = 0.001). There were no differences between the two groups in rates of hospitalization for any cause or in mortality. CONCLUSION: In this real world study, quadripolar LV leads have significantly lower rates of implantation failure and post-operative lead dislodgement or deactivation. These results have important clinical implications to CRT recipients.
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Rijal et al. (2016) conducted a cohort in Cardiac resynchronization therapy (CRT) recipients (n=1,441). Quadripolar left ventricular leads vs. Bipolar left ventricular leads was evaluated on Composite lead outcome defined as intra-operative lead implant failure or post-operative lead dislodgement or deactivations (HR 0.22, 95% CI 0.08-0.60, p=0.001). Quadripolar left ventricular leads were associated with a significantly lower risk of implant failure, dislodgement, or deactivation than bipolar leads (HR 0.22; 95% CI 0.08-0.60; p=0.001).
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