Effects of implantation of quadripolar left ventricular leads on CRT response

Julia W. Erath, Mate Vamos, Dominika Domokos, Alexander P. Benz, Zsolt Bari, Peter Bogyi, G. Duray, Stefan H. Hohnloser

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
Publication statusPublished - Jan 1 2019

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Cardiac Resynchronization Therapy
Defibrillators
Fluoroscopy
Sudden Death
Secondary Prevention
Tertiary Care Centers
Stroke Volume
Heart Ventricles
Comorbidity
Heart Diseases
Survival
Mortality

Keywords

  • Bipolar lead
  • Cardiac resynchronization therapy
  • CRT
  • CRT-D
  • Quadripolar lead
  • Response

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effects of implantation of quadripolar left ventricular leads on CRT response. / Erath, Julia W.; Vamos, Mate; Domokos, Dominika; Benz, Alexander P.; Bari, Zsolt; Bogyi, Peter; Duray, G.; Hohnloser, Stefan H.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Erath, Julia W. ; Vamos, Mate ; Domokos, Dominika ; Benz, Alexander P. ; Bari, Zsolt ; Bogyi, Peter ; Duray, G. ; Hohnloser, Stefan H. / Effects of implantation of quadripolar left ventricular leads on CRT response. In: Journal of Interventional Cardiac Electrophysiology. 2019.
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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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T1 - Effects of implantation of quadripolar left ventricular leads on CRT response

AU - Erath, Julia W.

AU - Vamos, Mate

AU - Domokos, Dominika

AU - Benz, Alexander P.

AU - Bari, Zsolt

AU - Bogyi, Peter

AU - Duray, G.

AU - Hohnloser, Stefan H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Bipolar lead

KW - Cardiac resynchronization therapy

KW - CRT

KW - CRT-D

KW - Quadripolar lead

KW - Response

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