Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead

Early results of a prospective multicenter study

Giovanni B. Forleo, Massimo Mantica, Luigi Di Biase, Germana Panattoni, Domenico G. Della Rocca, Lida P. Papavasileiou, Matteo Santamaria, Pasquale Santangeli, Andrea Avella, Domenico Sergi, Luca Santini, Claudio Tondo, Andrea Natale, Francesco Romeo

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Recent studies suggest that cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead results in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and at short-term follow-up. Confirmation of these results by long-term observational studies is needed. Objective: To evaluate the long-term procedural and clinical outcomes of CRT patients implanted with a quadripolar LV lead. Methods: A total of 154 consecutive heart failure patients (79% men, age 68 ± 10 years) having CRT implantation attempts with a quadripolar LV lead were included in this observational registry. Demographic and clinical data were preoperatively collected, and patients were followed up for at least 6 months. Results: The overall implant success rate after coronary sinus cannulation was 97.4%. Mean overall duration and fluoroscopy time of successful procedures was 112 ± 22 and 16 ± 8 minutes, respectively, while 17 ± 13 minutes were necessary for the LV lead placement. After implant, the conventional bipolar configuration was used as the final pacing configuration in 33.3% of the patients. Four lead dislodgments (requiring reoperation) and 9 clinical PNS were reported during follow-up; reprogramming of the device was sufficient to prevent PNS in all patients. Once placed, the LV lead remained stable with excellent pacing thresholds during follow-up (15 ± 5 months). Overall, there were 71.3% CRT responders as assessed by 6-month echocardiography, and 66% improved at least 1 New York Heart Association class. Conclusion: Over the longer term, CRT with the quadripolar LV lead is associated with excellent pacing thresholds, low rates of dislocations, and PNS.

Original languageEnglish (US)
JournalHeart Rhythm
Volume9
Issue number11
DOIs
StatePublished - Nov 2012
Externally publishedYes

Fingerprint

Cardiac Resynchronization Therapy
Multicenter Studies
Phrenic Nerve
Prospective Studies
Coronary Sinus
Fluoroscopy
Reoperation
Catheterization
Observational Studies
Registries
Echocardiography
Lead
Heart Failure
Demography
Equipment and Supplies

Keywords

  • Cardiac resynchronization therapy
  • Multiple pacing configurations
  • Phrenic nerve stimulation
  • Quadripolar left ventricular lead
  • Survey

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead : Early results of a prospective multicenter study. / Forleo, Giovanni B.; Mantica, Massimo; Di Biase, Luigi; Panattoni, Germana; Della Rocca, Domenico G.; Papavasileiou, Lida P.; Santamaria, Matteo; Santangeli, Pasquale; Avella, Andrea; Sergi, Domenico; Santini, Luca; Tondo, Claudio; Natale, Andrea; Romeo, Francesco.

In: Heart Rhythm, Vol. 9, No. 11, 11.2012.

Research output: Contribution to journalArticle

Forleo, GB, Mantica, M, Di Biase, L, Panattoni, G, Della Rocca, DG, Papavasileiou, LP, Santamaria, M, Santangeli, P, Avella, A, Sergi, D, Santini, L, Tondo, C, Natale, A & Romeo, F 2012, 'Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead: Early results of a prospective multicenter study', Heart Rhythm, vol. 9, no. 11. https://doi.org/10.1016/j.hrthm.2012.07.021
Forleo, Giovanni B. ; Mantica, Massimo ; Di Biase, Luigi ; Panattoni, Germana ; Della Rocca, Domenico G. ; Papavasileiou, Lida P. ; Santamaria, Matteo ; Santangeli, Pasquale ; Avella, Andrea ; Sergi, Domenico ; Santini, Luca ; Tondo, Claudio ; Natale, Andrea ; Romeo, Francesco. / Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead : Early results of a prospective multicenter study. In: Heart Rhythm. 2012 ; Vol. 9, No. 11.
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abstract = "Background: Recent studies suggest that cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead results in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and at short-term follow-up. Confirmation of these results by long-term observational studies is needed. Objective: To evaluate the long-term procedural and clinical outcomes of CRT patients implanted with a quadripolar LV lead. Methods: A total of 154 consecutive heart failure patients (79{\%} men, age 68 ± 10 years) having CRT implantation attempts with a quadripolar LV lead were included in this observational registry. Demographic and clinical data were preoperatively collected, and patients were followed up for at least 6 months. Results: The overall implant success rate after coronary sinus cannulation was 97.4{\%}. Mean overall duration and fluoroscopy time of successful procedures was 112 ± 22 and 16 ± 8 minutes, respectively, while 17 ± 13 minutes were necessary for the LV lead placement. After implant, the conventional bipolar configuration was used as the final pacing configuration in 33.3{\%} of the patients. Four lead dislodgments (requiring reoperation) and 9 clinical PNS were reported during follow-up; reprogramming of the device was sufficient to prevent PNS in all patients. Once placed, the LV lead remained stable with excellent pacing thresholds during follow-up (15 ± 5 months). Overall, there were 71.3{\%} CRT responders as assessed by 6-month echocardiography, and 66{\%} improved at least 1 New York Heart Association class. Conclusion: Over the longer term, CRT with the quadripolar LV lead is associated with excellent pacing thresholds, low rates of dislocations, and PNS.",
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AU - Panattoni, Germana

AU - Della Rocca, Domenico G.

AU - Papavasileiou, Lida P.

AU - Santamaria, Matteo

AU - Santangeli, Pasquale

AU - Avella, Andrea

AU - Sergi, Domenico

AU - Santini, Luca

AU - Tondo, Claudio

AU - Natale, Andrea

AU - Romeo, Francesco

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N2 - Background: Recent studies suggest that cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead results in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and at short-term follow-up. Confirmation of these results by long-term observational studies is needed. Objective: To evaluate the long-term procedural and clinical outcomes of CRT patients implanted with a quadripolar LV lead. Methods: A total of 154 consecutive heart failure patients (79% men, age 68 ± 10 years) having CRT implantation attempts with a quadripolar LV lead were included in this observational registry. Demographic and clinical data were preoperatively collected, and patients were followed up for at least 6 months. Results: The overall implant success rate after coronary sinus cannulation was 97.4%. Mean overall duration and fluoroscopy time of successful procedures was 112 ± 22 and 16 ± 8 minutes, respectively, while 17 ± 13 minutes were necessary for the LV lead placement. After implant, the conventional bipolar configuration was used as the final pacing configuration in 33.3% of the patients. Four lead dislodgments (requiring reoperation) and 9 clinical PNS were reported during follow-up; reprogramming of the device was sufficient to prevent PNS in all patients. Once placed, the LV lead remained stable with excellent pacing thresholds during follow-up (15 ± 5 months). Overall, there were 71.3% CRT responders as assessed by 6-month echocardiography, and 66% improved at least 1 New York Heart Association class. Conclusion: Over the longer term, CRT with the quadripolar LV lead is associated with excellent pacing thresholds, low rates of dislocations, and PNS.

AB - Background: Recent studies suggest that cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead results in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and at short-term follow-up. Confirmation of these results by long-term observational studies is needed. Objective: To evaluate the long-term procedural and clinical outcomes of CRT patients implanted with a quadripolar LV lead. Methods: A total of 154 consecutive heart failure patients (79% men, age 68 ± 10 years) having CRT implantation attempts with a quadripolar LV lead were included in this observational registry. Demographic and clinical data were preoperatively collected, and patients were followed up for at least 6 months. Results: The overall implant success rate after coronary sinus cannulation was 97.4%. Mean overall duration and fluoroscopy time of successful procedures was 112 ± 22 and 16 ± 8 minutes, respectively, while 17 ± 13 minutes were necessary for the LV lead placement. After implant, the conventional bipolar configuration was used as the final pacing configuration in 33.3% of the patients. Four lead dislodgments (requiring reoperation) and 9 clinical PNS were reported during follow-up; reprogramming of the device was sufficient to prevent PNS in all patients. Once placed, the LV lead remained stable with excellent pacing thresholds during follow-up (15 ± 5 months). Overall, there were 71.3% CRT responders as assessed by 6-month echocardiography, and 66% improved at least 1 New York Heart Association class. Conclusion: Over the longer term, CRT with the quadripolar LV lead is associated with excellent pacing thresholds, low rates of dislocations, and PNS.

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