title: Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead.
abstract: BACKGROUND
  Not all heart failure (HF) patients benefit from cardiac resynchronization therapy (CRT). We assessed whether choosing the site of left ventricular (LV) pacing by a quadripolar lead may improve response to CRT.
  
  
  RESULTS
  We prospectively randomized 23 patients with HF (67±11 years; 21 males) to CRT with a quadripolar LV lead (group 1, with the LV pacing site chosen on the basis of QRS shortening using simultaneous biventricular pacing), and 20 patients (71±6 years; 16 males) to a bipolar LV lead (group 2, with devices programmed with a conventional tip-to-ring configuration). New York Heart Association (NYHA) class and LV ejection fraction (EF) by 2D echocardiography were assessed at baseline and after 3 months. The baseline EF was not different between the 2 groups (25±6% group 1 vs. 27±3% group 2; P=0.22), but after 3 months EF was higher in group 1 (35±13% group 1 vs. 31±4% group 2; P<0.001). A reduction in at least 1 NYHA class at 3 months was observed in 22 (96%) and 12 (60%) of group 1 and group 2 patients, respectively (P<0.05).
  
  
  CONCLUSIONS
  CRT with a quadripolar LV lead was associated with an improvement of EF greater than that observed in patients receiving a bipolar LV lead. In devices with a quadripolar lead, CRT programming based on the best QRS shortening is reliable and effective. (Circ J 2016; 80: 613-618).
authors.affiliation: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bencardino
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Monaco
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.forename: Cristian
authors.initials: C
authors.lastname: Colizzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Perna
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Narducci
authors.forename: Francesca Augusta
authors.initials: FA
authors.lastname: Gabrielli
authors.forename: Gaetano Antonio
authors.initials: GA
authors.lastname: Lanza
authors.forename: Antonio Giuseppe
authors.initials: AG
authors.lastname: Rebuzzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies