| Objective: Several studies have confirmed that cardiac resynchronization therapy(CRT)can significantly improve the clinical symptoms of patients with chronic heart failure(CHF),reduced rehospitalizaiton rates and all-cause mortality,and a sort of research have demonstrated that CRT can reduce ventricular arrhythmia(VA)risk.More recently,the clinical application of left ventricular quadripolar lead provides more vector options and some studies have conformed that it is more advantageous in improving synchronicity and cardiac remodeling than bipolar lead.However,the incidence of VA after CRT with quadripolar lead have been little reported.This study was to observe the total number and burden of VA,the total number and burden of shock,and the total number and burden of antitachycardia pacing therapy(ATP)after cardiac resynchronization therapy defibrillator(CRT-D)with bipolar lead or quadripolar lead,then To evaluate incidence of postoperative ventricular arrhythmias in patients who received CRT-D with left ventricular quadripolar.Methods: The patients received CRT-D who had complete follow-up data in Anhui Provincial Hospital from June 2013 to June 2016 were selected and devided into quadripolar lead group and bipolar lead group according to the type of left ventricular lead.Patients who met the following criteria were included in this study.Inclusion criteria:(1)left ventricular ejection fraction(LVEF)≤35%;(2)New York Heart Association(NYHA)cardiac function class II-IV after standard drug therapy;and(3)QRS duration ≥120ms.And excluded patients with primary valvular disease,congenital heart disease,myocardial infarction or coronary artery bypass grafting in the 3 months,upgraded to CRT or CRT-D,and those with a life expectancy of less than 1 year.Preoperative baseline,age,gender,underlying disease,QRS duration,morphology,and ultrasound parameters were collected.Echocardiography was performed before and 6 months after CRT-D device implantation.The patients were followed up routinely at 1 month,3 months and 6 months after operation,followed up every 6 months after operation,recording VA、ATP and ICD shocks treatment,then the influence of quadripolar lead CRT-D on postoperative VA was analyzed.Results: Of the 220 patients enrolled in the study included quadripolar lead group(58)and bipolar lead group(162),and there were no significant differences between the two groups at baseline.According to the results,for the quadripolar lead group and the bipolar lead group,the VA episodes per patient was no significant difference between the two groups(0.60±2.38 VA per person vs 0.93±2.24 VA per person,P=0.055);The quadripolar lead group had a siginificantly lower burden of VA compared with bipolar lead group(0.22±0.91 per person-year vs 0.46±1.13 per person-year,P=0.044);Compared with bipolar lead group,there were sinificantly reduction in both the ICD shocks per patient and the burden of ICD shocks,(0.12±0.36 shocks per person vs 0.23±0.52 shocks per person,P=0.034)and(0.04±0.17 per person-year vs 0.12±0.46 per person-year,P=0.029),respectively.There were no siginificant defferences between the two groups in both the ATP per patient and the burden of ATP,(1.07±3.77 ATP per person vs 1.26±3.01 ATP per person,P=0.073)and(0.38±1.39 per person-year vs 0.63±1.48 per person-year,P=0.058),respectively.And there were no siginificant defferences between the two groups for the survival situation.Conclusion: Both CRT-D with bipolar lead and quadripolar lead can improve NYHA cardiac function and myocardial remodeling in patients with heart failure,whereas the quadripolar lead group improved significantly.Compared with bipolar lead group,the burden of VA could be significantly reduced after CRT-D in the quadripolar lead group;but no significant difference in survival benefit between the two groups.In addition,ICD primary prevention,Tp Te interphase,LVEDV,and lead type are independent influencing factors of VA after CRT-D. |
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