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JACC Clin Electrophysiol. 2016 Aug;2(4):426-433. doi: 10.1016/j.jacep.2016.02.007. Epub 2016 May 18.

Reduced Mortality Associated With Quadripolar Compared to Bipolar Left Ventricular Leads in Cardiac Resynchronization Therapy.

Author information

1
Division of Cardiology, Stanford University, Palo Alto, California. Electronic address: mintu@stanford.edu.
2
Golden Heart Medical, Rosemead, California.
3
St. Jude Medical, Sylmar, California.
4
Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.

Abstract

OBJECTIVES:

The study sought to compare survival, lead deactivation, and lead replacement with quadripolar versus bipolar leads using a retrospective cohort of patients with newly implanted cardiac resynchronization therapy (CRT) systems.

BACKGROUND:

In CRT, quadripolar left ventricular (LV) leads offer alternative pacing sites and vectors not available with bipolar LV leads, which may improve the effectiveness of the therapy.

METHODS:

Using nationwide data from device implant registration records of a single manufacturer, we identified patients with a de novo cardiac resynchronization therapy with defibrillation (CRT-D) implanted between November 30, 2011, and May 31, 2013. Patients were followed for up to 24 months. The primary predictor was LV lead type (quadripolar Quartet [St. Jude Medical, St. Paul, Minnesota] LV lead or bipolar LV lead). The primary outcome was death and the secondary outcomes were LV lead replacement and deactivation.

RESULTS:

Among 23,570 patients (69.5 ± 11.1 years of age; 28% female; median follow-up time 1.14 years), 18,406 had quadripolar and 5,164 had bipolar LV leads. The quadripolar and bipolar groups had 5.04 and 6.45 deaths per 100 patient-years, respectively (p < 0.001). After multivariate adjustment, the quadripolar lead was associated with a lower risk of deactivation (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.46 to 0.84; p = 0.002), replacement (HR: 0.67; 95% CI: 0.55 to 0.83; p < 0.001), and death (HR: 0.77; 95% CI: 0.69 to 0.86; p < 0.001).

CONCLUSIONS:

In this observational study of CRT-D devices, use of a quadripolar, compared to a bipolar LV lead, was associated with a reduction in LV lead deactivation, replacement, and mortality.

KEYWORDS:

cardiac resynchronization therapy; comparative effectiveness; left ventricular leads; outcomes; quadripolar

PMID:
29759861
DOI:
10.1016/j.jacep.2016.02.007
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