title: Cardiac Resynchronization Therapy Delivered Via a Multipolar Left Ventricular Lead is Associated with Reduced Mortality and Elimination of Phrenic Nerve Stimulation: Long-Term Follow-Up from a Multicenter Registry.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) using quadripolar left ventricular (LV) leads provides more pacing vectors compared to bipolar leads. This may avoid phrenic nerve stimulation (PNS) and allow optimal lead placement to maximize biventricular pacing. However, a long-term improvement in patient outcome has yet to be demonstrated.
  
  
  METHODS
  A total of 721 consecutive patients with conventional CRTD criteria implanted with quadripolar (n = 357) or bipolar (n = 364) LV leads were enrolled into a registry at 3 UK centers. Lead performance and mortality was analyzed over a 5-year period.
  
  
  RESULTS
  Patients receiving a quadripolar lead were of similar age and sex to those receiving a bipolar lead, although a lower proportion had ischemic heart disease (62.6% vs. 54.1%, P = 0.02). Both groups had similar rates of procedural success, although lead threshold, impedance, and procedural radiation dose were significantly lower in those receiving a quadripolar lead. PNS was more common in those with quadripolar leads (16.0% vs. 11.6%, P = 0.08), but was eliminated by switching pacing vector in all cases compared with 60% in the bipolar group (P < 0.001). Furthermore, LV lead displacement (1.7% vs. 4.6%, P = 0.03) and repositioning (2.0% vs. 5.2%, P = 0.03) occurred significantly less often in those with a quadripolar lead. All-cause mortality was also significantly lower in the quadripolar compared to bipolar lead group in univariate and multivariate analysis (13.2% vs. 22.5%, P < 0.001).
  
  
  CONCLUSIONS
  In a large, multicenter experience, the use of quadripolar LV leads for CRT was associated with elimination of PNS and lower overall mortality. This has important implications for LV pacing lead choice.
authors: Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK.|Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK.
authors: Jonathan M
authors: JM
authors: Behar
authors: Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK.|Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK.
authors: Julian
authors: J
authors: Bostock
authors: Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK.
authors: Adrian Po
authors: AP
authors: Zhu Li
authors: Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK.
authors: Hui Men Selina
authors: HM
authors: Chin
authors: Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK.
authors: Stephen
authors: S
authors: Jubb
authors: Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK.
authors: Edward
authors: E
authors: Lent
authors: Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK.
authors: James
authors: J
authors: Gamble
authors: Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK.|Great Western Hospital, Swindon, UK.
authors: Paul W X
authors: PW
authors: Foley
authors: Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK.
authors: Tim R
authors: TR
authors: Betts
authors: Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK.|Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK.
authors: Christopher Aldo
authors: CA
authors: Rinaldi
authors: Department of Cardiology, Guy's and St Thomas's NHS Foundation Trust, London, UK.|Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK.
authors: Neil
authors: N
authors: Herring
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D002423:Cause of Death; D016009:Chi-Square Distribution; D004739:England; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010791:Phrenic Nerve / Q000503:physiopathology*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: cardiac resynchronization therapy; implantable cardioverter defibrillator; left ventricular pacing; phrenic nerve stimulation; quadripolar lead
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