title: Single-center experience of a quadripolar pacing lead for cardiac resynchronization therapy.
abstract: OBJECTIVE
  Recent studies have shown that a quadripolar left ventricular (LV) lead can result in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and on medium-term follow-up in cardiac resynchronization therapy (CRT). We evaluated the outcomes of CRT patients in whom a quadripolar LV lead was implanted in our institution.
  
  
  METHODS
  We studied 45 consecutive heart failure patients (75 % men; age, 70.3 ± 9.0 years) following successful implantation of a quadripolar LV lead. Demographic and clinical data were collected preoperatively, and patients were followed up for 18.9 months.
  
  
  RESULTS
  The implantation success rate was 100 %. Mean overall duration was 100.1 ± 34.6 min, and X-ray exposure time was 13.20 ± 13.5 min. The most distal effective pacing site was used as the final pacing configuration in all patients. Acute dislodgment requiring reoperation occurred before discharge in three cases (6.6 %). Six patients (13 %) suffered PNS during follow-up; we solved this problem by changing the stimulation vector. Three months after implantation, a mean of six out of ten effective sites (threshold <2.5 V at 1.5 ms, no PNS) per patient was recorded.
  
  
  CONCLUSIONS
  Over the relatively long term, the quadripolar LV lead was associated with excellent pacing thresholds and low rates of dislocation and PNS.
authors.affiliation: EP Lab, Ospedale S.Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy, vado.a@ospedale.cuneo.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Vado
authors.forename: Endrj
authors.initials: E
authors.lastname: Menardi
authors.forename: Guido
authors.initials: G
authors.lastname: Rossetti
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Ballari
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Marco
authors.initials: M
authors.lastname: Bobbio
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects* / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology* / Q000517:prevention & control; D006333:Heart Failure / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D008297:Male; D016896:Treatment Outcome