Effective nonapical left ventricular pacing with quadripolar leads for cardiac resynchronization therapy.

BACKGROUND Current guidelines recommend to avoid apical left ventricular (LV) pacing for cardiac resynchronization therapy (CRT). AIM We investigated the feasibility of non-apical pacing with current quadripolar LV lead technology. METHODS We analyzed consecutive patients who received CRT with a LV quadripolar lead. Post-implantation position of each electrode of the LV lead was designated as basal, mid, or apical. The pacing (PCT) and the phrenic nerve stimulation (PNS) thresholds were assessed for each electrode. RESULTS We enrolled 168 patients. Eight CRT-D were from Biotronik (with Sentus OTW QP lead), 98 from Boston Scientific (21 Acuity X4 Spiral, 77 Acuity X4 Straight leads), and 62 from St Jude Medical (with Quartet lead). The median [25-75 percentile] number of electrodes at non-apical segments per patient was: 3 [1-4] with Biotronik Sentus, 4 [3-4] with spiral-design Boston Scientific leads, 4 [3-4] with straight Boston Scientific, 3 [3-4] with St Jude Medical Quartet (P = 0.045). Three (38%) patients with Biotronik Sentus, 21 (100%) with spiral-design Boston Scientific, 69 (90%) with straight-design Boston Scientific, and 49 (79%) with St Jude Medical Quartet (P < 0.001) had at least one electrode located at non-apical segments linked with a PNS-PCT safety margin > 2 V. During the 6-months follow-up, PNS was detected in 4 patients and was eliminated with reprogramming. No significant changes in PCT were detected from baseline to follow-up. CONCLUSIONS Quadripolar leads allowed non-apical pacing with acceptable electrical parameters in the majority of CRT recipients, although dissimilarity appeared among currently available devices.

[1]  M. Bertini,et al.  Single- and multi-site pacing strategies for optimal cardiac resynchronization therapy: impact on device longevity and therapy cost , 2020, Journal of Interventional Cardiac Electrophysiology.

[2]  A. Curnis,et al.  Clinical and economic impact of multipoint left ventricular pacing: A comparative analysis from the Italian registry on multipoint pacing in cardiac resynchronization therapy (IRON‐MPP) , 2020, Journal of cardiovascular electrophysiology.

[3]  G. Boriani,et al.  Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads , 2018, Scientific Reports.

[4]  C. Rinaldi,et al.  Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions , 2018, Heart Failure Reviews.

[5]  F. Leyva,et al.  Cardiac Resynchronization Therapy Using Quadripolar Versus Non‐Quadripolar Left Ventricular Leads Programmed to Biventricular Pacing With Single‐Site Left Ventricular Pacing: Impact on Survival and Heart Failure Hospitalization , 2017, Journal of the American Heart Association.

[6]  C. Leclercq,et al.  Avoiding non-responders to cardiac resynchronization therapy: a practical guide , 2016, European heart journal.

[7]  L. Di Biase,et al.  Multipoint pacing via a quadripolar left-ventricular lead: preliminary results from the Italian registry on multipoint left-ventricular pacing in cardiac resynchronization therapy (IRON-MPP) , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[8]  P. Ponikowski,et al.  [2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure]. , 2016, Kardiologia polska.

[9]  Nigel Gupta,et al.  Performance of Anatomically Designed Quadripolar Left Ventricular Leads: Results from the NAVIGATE X4 Clinical Trial , 2016, Journal of cardiovascular electrophysiology.

[10]  Michael Cao,et al.  Reduced Mortality Associated With Quadripolar Compared to Bipolar Left Ventricular Leads in Cardiac Resynchronization Therapy. , 2016, JACC. Clinical electrophysiology.

[11]  J. Brachmann,et al.  Effectiveness and Reliability of Selected Site Pacing for Avoidance of Phrenic Nerve Stimulation in CRT Patients with Quadripolar LV Leads: The EffaceQ Study , 2015, Pacing and clinical electrophysiology : PACE.

[12]  C. Morillo,et al.  Left Ventricular Three‐Dimensional Quadripolar Lead Acute Clinical Study: The LILAC Study , 2015, Pacing and clinical electrophysiology : PACE.

[13]  A. Natale,et al.  Hospitalization rates and associated cost analysis of cardiac resynchronization therapy with an implantable defibrillator and quadripolar vs. bipolar left ventricular leads: a comparative effectiveness study , 2014, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[14]  J. Ottervanger,et al.  Incidence of lead dislodgement, malfunction and perforation during the first year following device implantation , 2014, Netherlands Heart Journal.

[15]  R. Verlato,et al.  Incremental Value of Larger Interventricular Conduction Time in Improving Cardiac Resynchronization Therapy Outcome in Patients with Different QRS Duration , 2014, Journal of cardiovascular electrophysiology.

[16]  J. Healey,et al.  Left ventricular lead position and outcomes in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). , 2014, Canadian Journal of Cardiology.

[17]  A. Natale,et al.  Improved implant and postoperative lead performance in CRT-D patients implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study , 2014, Journal of Interventional Cardiac Electrophysiology.

[18]  K. Dickstein,et al.  Meta‐analysis of symptomatic response attributable to the pacing component of cardiac resynchronization therapy , 2013, European journal of heart failure.

[19]  M. Biffi,et al.  Occurrence of phrenic nerve stimulation in cardiac resynchronization therapy patients: the role of left ventricular lead type and placement site. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[20]  A. Natale,et al.  Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead: early results of a prospective multicenter study. , 2012, Heart rhythm.

[21]  Erwan Donal,et al.  Sites of left and right ventricular lead implantation and response to cardiac resynchronization therapy observations from the REVERSE trial. , 2012, European heart journal.

[22]  G. Boriani,et al.  Management of Phrenic Stimulation in CRT Patients over the Long Term: Still an Unmet Need ? , 2011, Pacing and clinical electrophysiology : PACE.

[23]  Kenneth A. Ellenbogen,et al.  The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy , 2011, European heart journal.

[24]  Wojciech Zareba,et al.  Left Ventricular Lead Position and Clinical Outcome in the Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT) Trial , 2011, Circulation.

[25]  F. Romeo,et al.  Left ventricular pacing with a new quadripolar transvenous lead for CRT: early results of a prospective comparison with conventional implant outcomes. , 2011, Heart rhythm.

[26]  Wojciech Zareba,et al.  Cardiac-resynchronization therapy for the prevention of heart-failure events. , 2009, The New England journal of medicine.

[27]  Wilfried Mullens,et al.  Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. , 2009, Journal of the American College of Cardiology.

[28]  C. Schneider,et al.  ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. , 2008, European heart journal.

[29]  D. Exner,et al.  Relationship between left ventricular lead position using a simple radiographic classification scheme and long-term outcome with resynchronization therapy , 2008, Journal of Interventional Cardiac Electrophysiology.

[30]  J. Daubert,et al.  Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects , 2001, Heart.