First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Cardiac resynchronization therapy (CRT) can be complicated by elevated pacing thresholds and phrenic nerve stimulation (PNS).
• These complications often necessitate coronary sinus lead repositioning.
• A novel quadripolar electrode lead and CRT-defibrillator (CRT-D) system aims to mitigate these issues through electrical repositioning.

Purpose of the Study:

• To evaluate the performance of a novel quadripolar electrode lead and CRT-D device.
• To assess the potential of electrical repositioning to avoid lead revision procedures.
• To determine the efficacy in managing pacing thresholds and PNS.

Main Methods:

• Seventy-five patients indicated for CRT were enrolled and implanted with a quadripolar electrode lead and CRT-D device.
• Electrical data and presence of PNS were documented for each left ventricular (LV) configuration.
• Measurements were taken pre-hospital discharge and at 1-month follow-up.

Main Results:

• 71 patients were successfully implanted with the quadripolar lead.
• Electrical measurements remained stable throughout the follow-up period.
• 97% of patients had programmable configurations with < 2.5 V threshold and no PNS, compared to 86% with conventional bipolar configurations.
• Physicians utilized programming options to manage threshold changes and PNS effectively.
• 11% of patients experienced PNS on all conventional bipolar vectors.

Conclusions:

• The quadripolar electrode LV lead offers enhanced programming flexibility for CRT management.
• New electrical vector measurements are comparable to conventional configurations.
• This technology provides a valuable alternative for addressing common CRT complications like PNS.