title: A Meta-Analysis Of Quadripolar Versus Bipolar Left Ventricular Leads On Post-Procedural Outcomes.
abstract: Objective:We aimed to perform a meta-analysis from eligible studies to analyze the true impact of QL when compared with BL with regard to post-procedural outcomes including lead deactivation, revision or replacement.Background:Many observational and retrospective studies showed that quadripolar left ventricular leads (QL) are associated with better outcomes and fewer complications when compared with bipolar leads (BL).Methods:We performed a comprehensive literature search through June 30, 2015 using: quadripolar, bipolar, left ventricular lead and CRT in Pubmed, Ebsco and google scholar databases.Results:The analysis included 8 studies comparing QL and BL implantation. Post-procedural outcomes such as lead deactivation, revision or replacement were used as primary outcome and assessed with Mantel-Haenszel risk ratio (RR). Secondary outcomes included total fluoroscopy/procedure time, occurrence of phrenic nerve stimulation (PNS) and all-cause mortality on follow up. Follow-up duration for the studies ranged from 3 to 60 months. Compared with BL, the use of QL is associated with 52 % reduction (relative risk 0.48; 95% CI: 0.36-0.64, p=0.00001) in the risk of deactivation, revision or replacement of the LV lead. QL had significantly lower fluoroscopy/procedure time, PNS and all-cause mortality when compared with BL.Conclusion:Our meta-analysis shows that QL implantation was associated with decreased risk of LV lead deactivation, revision or replacement when compared with BL.
authors.affiliation: Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, MO.
authors.forename: Mohit K
authors.initials: MK
authors.lastname: Turagam
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS.
authors.forename: Sandia
authors.initials: S
authors.lastname: Iskander
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS.
authors.lastname: Madhu-Reddy
authors.affiliation: Albert Einstein College of Medicine, New York, NY.
authors.forename: Luigi Di
authors.initials: LD
authors.lastname: Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
keywords: Bipolar Lead; Cardiac Resynchronization Therapy; Congestive Heart Failure; Meta-Analysis; Quadripolar Lead