title: First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is sometimes complicated by elevated pacing thresholds and phrenic nerve stimulation (PNS), both of which may require that the coronary sinus lead be repositioned. The purpose of this study was to evaluate the performance of a novel quadripolar electrode lead and cardiac resynchronization therapy-defibrillator (CRT-D) device that enables electrical repositioning, potentially obviating a lead reposition procedure.
  
  
  RESULTS
  Patients indicated for CRT were enrolled and received a quadripolar electrode lead and CRT-D device (Quartetmodel 1458Q and Promote Q; St Jude Medical, Sylmar, CA, USA). Electrical data, and the presence of PNS during pacing from each left ventricular (LV) configuration, were documented at pre-hospital discharge and at 1 month. Seventy-five patients were enrolled and 71 were successfully implanted with a Quartetlead. Electrical measurements were stable over the follow-up period. Ninety-seven per cent (64 of 66) of patients had one or more programmable configurations with a threshold < 2.5 V and no PNS vs. 86% (57 of 66) if only conventional bipolar configurations were considered. Physicians were able to use the increased programming options to manage threshold changes and PNS.
  
  
  CONCLUSIONS
  The new quadripolar electrode LV lead provides more programming options to address common problems faced when managing CRT patients. Electrical measurements from new vectors are comparable with conventional configurations. Furthermore, 11% of patients in the study suffered PNS on all conventional bipolar vectors.
authors: Cardiology Department, Kerckhoff-Klinik GmbH, Benekestr 2-8, 61231, Bad Nauheim, Germany. j.sperzel@kerckhoff-klinik.de
authors: Johannes
authors: J
authors: Sperzel
authors: Wilfried
authors: W
authors: Dänschel
authors: Klaus-Jürgen
authors: KJ
authors: Gutleben
authors: Wolfgang
authors: W
authors: Kranig
authors: Peter
authors: P
authors: Mortensen
authors: Derek
authors: D
authors: Connelly
authors: Hans-Joachim
authors: HJ
authors: Trappe
authors: Karlheinz
authors: K
authors: Seidl
authors: Gabor
authors: G
authors: Duray
authors: Burkert
authors: B
authors: Pieske
authors: Jochem
authors: J
authors: Stockinger
authors: Giuseppe
authors: G
authors: Boriani
authors: Werner
authors: W
authors: Jung
authors: Richard
authors: R
authors: Schilling
authors: Linda
authors: L
authors: Saberi
authors: Benoit
authors: B
authors: Hallier
authors: Marcus
authors: M
authors: Simon
authors: Christopher A
authors: CA
authors: Rinaldi
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D004567:Electrodes, Implanted; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D010791:Phrenic Nerve / Q000503:physiopathology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy