title: Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study.
abstract: BACKGROUND
  To understand the impact of a quadripolar left ventricular (LV) lead on reverse remodeling and phrenic nerve stimulation (PNS) in congestive heart failure patients treated by cardiac resynchronization therapy at 8-month follow-up (FU).
  
  
  METHODS
  One hundred and fifty-eight patients received an LV Medtronic Performa lead (Medtronic Inc., Minneapolis, MN, USA) and were reevaluated at FU by echocardiography and measurement of electrical parameters.
  
  
  RESULTS
  A targeted LV lead placement was achieved in 140 (89%) patients. Super responders and responders were 76 (50%) and 26 (18%), respectively, at FU; seven (4%) died and 13 (8%) were hospitalized for any cause. Nonischemic etiology was the only independent predictor of reverse remodeling. The configurations available only with the Performa leads reduced PNS occurrence at 8 V@0.4 ms from 43 (27%) to 14 (9%) of patients at implantation, and from 44 (28%) to 19 (12%) at last FU, compared to configurations available with bipolar leads. Patients with detectable PNS had >10/16 pacing configurations with a PNS safety margin >2 V both at implantation and at FU. During FU 16 (10%) patients had an adverse event possibly related to the lead or to modification of the underlying heart disease but 99% of these events were fixed by reprogramming of the pacing vector.
  
  
  CONCLUSIONS
  Performa Lead enables an increased capability to achieve a targeted lead positioning in the broad clinical scenario of large- and small-volume implanting centers, with a relevant impact on the occurrence of reverse remodeling compared to literature data. The enhanced management of PNS resulted in a dislodgement rate of only 1%.
authors.affiliation: Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.affiliation: Division of Cardiology, Infermi Hospital, Rimini, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Saporito
authors.affiliation: Division of Cardiology, University Hospital, Parma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zardini
authors.affiliation: Cardiovascular Department, Ospedali Riuniti, Ancona, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Luzi
authors.affiliation: Division of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Quartieri
authors.affiliation: Division of Cardiology, Macerata Hospital, Macerata, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Morgagni
authors.affiliation: Division of Cardiology, Ramazzini Hospital, Carpi, Italy.
authors.forename: Elia
authors.initials: E
authors.lastname: De Maria
authors.affiliation: Division of Cardiology, S.Anna Hospital, Ferrara, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.affiliation: Division of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Carinci
authors.affiliation: Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D007558:Italy; D008297:Male; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D020257:Ventricular Remodeling
keywords: cardiac resynchronization therapy; heart failure; reverse remodeling; short-spaced quadripolar lead