title: Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead: early results of a prospective multicenter study.
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.
  
  
  CONCLUSIONS
  Over the longer term, CRT with the quadripolar LV lead is associated with excellent pacing thresholds, low rates of dislocations, and PNS.
authors: Department of Internal Medicine, Division of Cardiology, University of Rome Tor Vergata, Rome, Italy. forleo@me.com
authors: Giovanni B
authors: GB
authors: Forleo
authors: Massimo
authors: M
authors: Mantica
authors: Luigi
authors: L
authors: Di Biase
authors: Germana
authors: G
authors: Panattoni
authors: Domenico G
authors: DG
authors: Della Rocca
authors: Lida P
authors: LP
authors: Papavasileiou
authors: Matteo
authors: M
authors: Santamaria
authors: Pasquale
authors: P
authors: Santangeli
authors: Andrea
authors: A
authors: Avella
authors: Domenico
authors: D
authors: Sergi
authors: Luca
authors: L
authors: Santini
authors: Claudio
authors: C
authors: Tondo
authors: Andrea
authors: A
authors: Natale
authors: Francesco
authors: F
authors: Romeo
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D016009:Chi-Square Distribution; D004452:Echocardiography; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*