Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead
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Key result
Cardiac resynchronization therapy with a quadripolar left ventricular lead significantly improved left ventricular ejection fraction (35% vs 31%) and NYHA class responder rate (96% vs 60%) compared to a bipolar lead at 3 months.
Why the study?
Does CRT with a quadripolar LV lead programmed for best QRS shortening improve LVEF and NYHA class compared to a conventional bipolar LV lead in patients with heart failure?
Population
43 consecutive patients with heart failure referred for cardiac resynchronization therapy, mean age 69±9…
Comparison
Cardiac resynchronization therapy using a… vs Cardiac resynchronization therapy using a…
Design
RCT, Randomized using a computer-generated table of random numbers., Patients…
Follow-up
3 months
Authors
Discussion
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Implication
QRS optimization with quadripolar leads may enhance CRT response; leaves open confirmation in larger randomized trials.
Study Design
Type
RCT (n=43)
Blinding
Single-blind
Randomization
Computer-generated table of random numbers
Multicenter
No
Structured PICO
Does CRT with a quadripolar LV lead programmed for best QRS shortening improve LVEF and NYHA class compared to a conventional bipolar LV lead in patients with heart failure?
P
Population
43 patients with heart failure, ejection fraction <35%, and QRS ≥130 ms with LBBB morphology, followed for 3 months.
I
Intervention
Cardiac resynchronization therapy (CRT) using a quadripolar left ventricular lead, with the pacing site chosen based on the best QRS shortening using simultaneous biventricular pacing.
C
Comparator
Cardiac resynchronization therapy (CRT) using a bipolar left ventricular lead, programmed with a conventional tip-to-ring configuration.
O
Outcome
Change in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class at 3 months.surrogate
Main Result
Absolute Event Rate: 35% vs 31%
p-value: p=<0.001
Using a quadripolar LV lead to optimize the pacing site based on QRS shortening significantly improves LVEF and clinical response in heart failure patients undergoing CRT compared to conventional bipolar leads.
Limitations
- Small number of patients enrolled in a single-center study
- Study was not double-blind
- Echocardiographic measurements were performed by a single operator
- Echocardiographic quantification of LV dyssynchrony was not routinely tested
- Short follow-up time of 3 months
- Echocardiographic measurements were done by a single operator
- Only mid-term follow-up (3 months)
Cite This Study
Bencardino et al. (2016) conducted an RCT in Heart failure (n=43). Cardiac resynchronization therapy with a quadripolar left ventricular lead vs. Cardiac resynchronization therapy with a bipolar left ventricular lead was evaluated on Left ventricular ejection fraction at 3 months (p=<0.001). Cardiac resynchronization therapy with a quadripolar left ventricular lead significantly improved left ventricular ejection fraction (35% vs 31%) and NYHA class responder rate (96% vs 60%) compared to a bipolar lead at 3 months.
Topics
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