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Effects of implantation of quadripolar left ventricular leads on CRT response

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The use of quadripolar (QP) left ventricular leads for cardiac resynchronization therapy (CRT) is intended to improve outcomes compared with conventional bipolar leads (BP). Hence, the number of implanted quadripolar CRT systems is increasing despite limited long-term data.

Purpose

The aim of this study is to evaluate clinical response and long-term outcomes of CRT recipients who were implanted with quadripolar versus bipolar left ventricular leads.

Methods

Data from consecutive patients receiving a CRT defibrillator in one German and one Hungarian tertiary referral center were retrospectively collected. Long-term survival and response to CRT were analyzed.

Results

A total of 536 patients with structural heart disease and a mean left ventricular ejection fraction (LVEF) of 25% received a CRT defibrillator (CRT-D) system for primary (79%) or secondary (21%) prevention of sudden death. Comorbidities did not differ significantly between patients receiving a QP (n = 123) or a BP lead (n = 413). Procedure (101 vs. 120 min) and fluoroscopy times (14 vs. 20 min) were shorter in patients implanted with QP compared with BP (both p < 0.001). At 6 months follow-up, QP patients were more likely to respond to CRT measured as improvement in the New York Heart Association (NYHA) functional class (77% vs. 63%; p < 0.001). Use of QP left ventricle/left ventricular (LV) leads was associated with greater reduction in QRS duration compared with patients implanted with BP LV leads (− 21 ± 30 vs. − 8 ± 35 ms, p = 0.004). Mortality was not significantly different between patients with QP and patients with BP LV leads at a mean follow-up of 39 ± 31 months.

Conclusion

Implantation of quadripolar left ventricular leads was associated with better CRT response compared with bipolar left ventricular leads.

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Abbreviations

ACE-inhibitor:

Angiotensin-converting-enzyme inhibitor

ARB:

Angiotensin receptor blocker

ASA:

Acetylsalicylacid

BP:

Bipolar

BiVPace:

Biventricular pacing percentage

CAD:

Coronary artery disease

CI:

Confidence interval

CKD:

Chronic kidney disease (stage III KDIGO, GFR ≤ 59 ml/min)

CRT:

Cardiac resynchronization therapy

CRT-D:

Implantable cardioverter defibrillator with CRT

FDA:

Federal drug association

HR:

Hazard ratio

ICD:

Implantable cardioverter defibrillator

IRB:

Institutional review board

LBBB:

Left bundle branch block

LMWH:

Low-molecular-weight heparin

LV:

Left ventricle/left ventricular

LVEF:

Left ventricular ejection fraction

LVEDD:

Left ventricular end diastolic diameter

MRAs:

Mineralocorticoid receptor antagonists

NOAC:

Non-VKA oral anticoagulant

NYHA:

New York Heart Association functional classification

PAD:

Peripheral artery disease

QP:

Quadripolar

SCD:

Sudden cardiac death

SD:

Standard deviation

VKA:

Vitamin K antagonist

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Authors and Affiliations

  1. Department of Cardiology, Division of Clinical Electrophysiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Julia W. Erath, Mate Vamos, Alexander P. Benz & Stefan H. Hohnloser

  2. Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary

    Dominika Domokos, Zsolt Bari, Peter Bogyi & Gabor Z. Duray

Authors
  1. Julia W. Erath
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  2. Mate Vamos
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  3. Dominika Domokos
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  4. Alexander P. Benz
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  5. Zsolt Bari
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  6. Peter Bogyi
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  7. Gabor Z. Duray
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  8. Stefan H. Hohnloser
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Corresponding author

Correspondence to Stefan H. Hohnloser.

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Conflict of interest

J. W. E. reports receiving consulting fees, travel support, and lecture fees from ZOLL Medical, travel grants from St. Jude Medical/Abbott, and lecture fees from Servier and is a fellow of the Boston Scientific Heart Rhythm fellowship program outside the submitted work.

M.V. reports receiving lecture/consulting fees from Bayer, BMS, Daiichi Sankyo, and Pfizer and support attending scientific meetings from Bayer, Daiichi-Sankyo, Egis, Pfizer, and SJM, outside the submitted work.

D. D. has nothing to disclose.

A. P. B. has nothing to disclose.

Z.B. has nothing to disclose.

P. B. has nothing to disclose.

G.Z.D. reports speakers’ bureau from Medtronic, Biotronik, SJM, and Johnson & Johnson outside the submitted work.

S.H.H. reports receiving consulting fees from Bayer, BI, Boston Scientific, BMS, Gilead, J&J, Medtronic, Pfizer, SJM, Sanofi-Aventis, ZOLL Medical, and Cardiome outside the submitted work.

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Erath, J.W., Vamos, M., Domokos, D. et al. Effects of implantation of quadripolar left ventricular leads on CRT response. J Interv Card Electrophysiol 55, 73–81 (2019). https://doi.org/10.1007/s10840-019-00545-8

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  • DOI: https://doi.org/10.1007/s10840-019-00545-8

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