| 【Objective】The application of quadripolar left ventricular lead in china has been just started,the clinical efficacy and differences between quadripolar and bipolar lead are not clear.This study aimed to evaluate:1.The differences between quadripolar lead and bipolar lead in improving cardiac electrical,mechanical synchrony and cacute hemodynamics;2.The differences between quadripolar lead and bipolar lead in clinical efficacy;3.The differences between quadripolar lead and bipolar lead in electrical and mechanical reverse remodeling of atrium and ventricular after CRT implantation.4.The differences between quadripolar lead and bipolar lead in ventricular arrhythmia after CRT implantation;5.The differences between quadripolar lead and bipolar lead in clinical prognosis after CRT implantation.【Methods】This was a prospective observational study,selecting patients who were in accordance with the inclusions for cardiac chronization therapy defrbrillator(CRT-D).Patients were devided into quadripolar lead group and bipolar lead group according to the type of left ventricular lead.The baseline data,such as sex and age were recorded.The QRS duration was measured with the maximum value in the 12-lead electrocardiogram,the P wave time and P wave dipersion were measured as well.Aortic velocity time integral(AOVTI)and pulmonary artery systolic pressure(PASP)were messured with echocardiography.Left atrial volume(LAV),left ventricular end systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),maximum difference in minimum contraction volume time of 16 segments(Tmsv-dif)and the 16 segments of the RR interval correction reached the minimum contraction volume time standard deviation(Tmsv16-SD%)were measured by three-dimensional echocardiography.The patients were followed up routinely at 1 month,3 months and 6 monthes after implantation of CRT,followed up every 3 months.Follow-up were in pacemaker clinic,and ventricular arrhythmia(VA)was recorded.The primary endpoints of the study were hospitalization for heart failure and all cause death.CRT response was defined as ≥15% reduction in LVESV 6 months later after CRT-D implantation.Electrical reverse remodeling was defined as ≥20ms reduction in QRS duration 6 months later after CRT-D implantation.【Results】A total of 155 patients were enrolled,of whom 57 were in quadripolar lead group and 98 in bipolar lead group.There was no significant difference in sex,age,cardiac rhythm,hypertension,diabetes mellitus,the levels of hemoglobin and creatinine,primary prevention ratio of ICD,QRS duration,LAV,LVEDV,LVESV,LVEF,PASP and drug use between the two groups.1.The quadripolar leads provided more viable LVPSs compared with the bipolar leads.The percentage of patients with at least 1,2,3,and 4 viable LVPSs were 100%,96.5%,84.2% and 64.9% for quadripolar leads,100%,76.5%(P=0.001),15.3%(P<0.001)and 0%(P<0.001)for the bipolar leads,respectively.2.The improvement of AOVTI(19.3±4.0cm vs 17.7±3.3cm,P=0.007)in quadripolar lead group after implantation of CRT was better than that of bipolar lead group.QRS duration(159.3±20.3ms vs 144.4±16.7ms,P<0.001)decreased significantly after CRT.The QRS duration(139.0±14.8 ms vs 147.5±16.9ms,P=0.002)in quadripolar lead group was narrower than that of bipolar lead group.Tmsv-dif [181.1(134.0,194.0)ms vs 109.6(65.5,121.0)ms,P<0.001] and Tmsv-SD(14.4±4.6 %R-R vs 8.5±4.3 %R-R,P<0.001)were improved significantly after CRT.The improvement of Tmsv-dif [95.3(59.3,108.3)ms vs 117.8(78.5,128.5)ms,P=0.009] and Tmsv-SD(7.4±4.0 %R-R vs 9.2±4.3 %R-R,P=0.012)in quadripolar lead group was more significant than in bipolar lead group.3.The total number of responder is 90,there is 40(71.4%)responders in quadripolar lead group,and the number is 50(51.5%)in bipolar lead group,The difference is statistically significant(P=0.016).The single factor analysis showed that quadripolar lead,QRS duration,PASP,LAV and P wave duration were the factors that affect the effect of CRT(P<0.10).Binary logistic regression analysis showed that quadripolar lead,QRS duration,PASP,LAV were the independent influence factors that affect the effect of CRT.The survival analysis of VA events showed that the risk of occurrence of the VA in quadripolar lead group was lower.4.There were no difference in improvement of LVEDV,LVESV and LAV between the two groups.The improvements of LVESV and LAVwere more significantly in responders in quadripolar lead group than that in bipolar lead group(all P<0.05).The improvements of LVEF(37.5±7.8% vs 34.1±7.0%,P=0.008)was more significantly in quadripolar lead group than that in bipolar lead group.5.The proportion of electrical reverse myocardial remodeling in quadripolar lead group is higher than that of bipolar lead group(58.8% vs 41.0%,P=0.044).The risk of occurrence of the VA in electrical reverse myocardial remodeling group was lower than that of non electrical reverse myocardial remodeling group(P=0.029).There were no difference in P wav duration(120.5±19.3ms vs 124.4±14.8 ms,P>0.05)and dispersion(47.2±10.4ms vs 49.3±8.8 ms,P>0.05)between the two groups before CRT.P wav duration and dispersion were both improved after CRT in the two groups(all P<0.001).The improvements of P wav duration(103.1±17.4ms vs 111.4±15.6ms,P=0.010)and dispersion(39.0±7.1ms vs 44.1±8.2ms,P=0.001)were more significantly in quadripolar lead group than that in bipolar lead group.6.There were 15(26.3%)cases of inpatient with heart failure and all cause of death in quadripolar lead group,and the number was 43(43.9%)in bipolar lead group.Survival analysis showed that the risk of the primary endpoints in quadripolar lead group was lower than that in bipolar conductor group(P=0.002).The risk of the primary endpoints in response group was lower than that in non-response group(P<0.001).The risks of VA events and primary endpoints in super-response group were lower than that in non super-response group.【Conclusions】Compared with bipolar lead group,CRT with quadripolar lead could get better electrical and mechanical synchronicity,acute hemodynamics and clinical efficacy.Quadripolar lead group could further got electrical and mechanical reverse remodeling of the atria and ventricular than bipolar lead group.Compared with bipolar lead group,the quadripolar lead group had lower risk of ventricular arrhythmia and better clinical prognosis. |
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