The Clinical Effect Of Quadripolar Left Ventricular Lead In Cardiac Resynchronization Therapy

Objective:Our aim was to evaluate the clinical effect of quadripolar LV lead implanted in cardiac resynchronization therapy(CRT).Methods:Retrospective analysis was performed on heart failure patients following successful implantation of St.Jude LV lead from January 2014 to December 2015 at The Second Affiliated Hospital,Zhejiang University College of Medicine.The duration of LV lead implantation procedure,the implanted position of LV lead and the selected pacing vector during the operation was assessed.After 6 to 12-month follow-up,clinical effects like left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),NYHA class,CRT response,as well as complications like phrenic nerve stimulation(PNS)were compared between the two groups.Results:In our study,46 patients implanted with CRT were included,with 22 patients in quadripolar LV lead group and 24 patients in bipolar LV lead group.There were no difference of LVEF,LVEDD and concomitant disease between the two groups.The duration of LV lead implantation procedure in quadripolar lead group seemed shorter than those in bipolar lead group,although without statistical difference[(60.0±33.5)min VS(66.2±33.9)min,P>0.05],and apex pacing in quadripolar lead group was lower(0%vs 16.7%,P<0.05).During implantation,PNS was occurred in 8 cases in quadripolar lead group,7 of which were overcame by reprogramming pacing vector,and 5 cases in bipolar lead group,which were all changed their target vessel.After 13.4 ±4.1 months follow-up,NYHA class and LVEF improved significantly(P<0.05).Compared with bipolar lead group,LVEF had a greater improvement in quadripolar lead group at 6-month follow-up[(42.1 ±6.6)%VS(35.1 ±8.7)%,P<0.05],and the same as CRT response(81.8%VS 54.2%,P<0.05).During follow-up,PNS was occurred in 4 cases in quadripolar lead group,which were all overcame by reprogramming pacing vector,and 2 cases in bipolar lead group,which were overcame by reducing output and increasing pulse width.LV lead dislocation was happened in one patient in quadripolar lead group at 1-month follow-up.Conclusions:Compared with bipolar LV lead,the Quartet quadripolar LV lead proved to be better at avoiding apex pacing,reducing complications like PNS,and improving the clinical effect at short-time follow-up.