title: Lead related complications in quadripolar versus bipolar left ventricular leads.
abstract: BACKGROUND
  Quadripolar left ventricular (LV) leads are capable of pacing from four different electrodes which allows for easier and more stable intra-operative lead positioning with optimal pacing parameters. We therefore investigated the rate of combined intra-operative and post-operative LV lead related events in quadripolar vs. bipolar LV lead cardiac resynchronization therapy (CRT) recipients in the real world setting.
  
  
  METHODS
  We retrospectively collected data for N = 1441 patients at our institution implanted with quadripolar (n = 292) or bipolar (n = 1149) LV leads from 2012 to 2014 and followed them to the primary end-point of composite lead outcome defined as intra-operative lead implant failure or post-operative lead dislodgement or deactivations.
  
  
  RESULTS
  Patients implanted with a quadripolar lead were younger (70.6 ± 11.4 vs 72.5 ± 11.6, p = 0.014) and had higher incidence of diabetes (41.8% vs 32.8%, p = 0.004) compared to those with bipolar leads. All other baseline characteristics were comparable. Patients implanted with a quadripolar were significantly less likely to reach the primary endpoint in the first 12 months after LV lead implantation (Hazard Ratio 0.22, 95% Confidence Interval 0.08-0.60, p = 0.001). There were no differences between the two groups in rates of hospitalization for any cause or in mortality.
  
  
  CONCLUSIONS
  In this real world study, quadripolar LV leads have significantly lower rates of implantation failure and post-operative lead dislodgement or deactivation. These results have important clinical implications to CRT recipients.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Shasank
authors.initials: S
authors.lastname: Rijal
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wolfe
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Rohit
authors.initials: R
authors.lastname: Rattan
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Asad
authors.initials: A
authors.lastname: Durrani
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Althouse
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Suresh
authors.initials: S
authors.lastname: Mulukutla
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. Electronic address: sabas@upmc.edu.
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
keywords: Bipolar; Cardiac resynchronization therapy; Complications; Left ventricular lead; Quadripolar