Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads
M Ziacchi1, I Diemberger2, A Corzani2
1Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. matteo.ziacchi@gmail.com.
Scientific Reports
|September 7, 2018
Summary
Quadripolar (QL) and active fixation leads (AFL) show improved performance in cardiac resynchronization therapy compared to bipolar leads (BL). Non-BL leads predict better clinical outcomes, with AFL preventing dislodgement and QL managing phrenic nerve stimulation effectively.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Left ventricular (LV) lead choice impacts cardiac resynchronization therapy (CRT) effectiveness.
- Bipolar (BL), quadripolar (QL), and active fixation leads (AFL) are common LV lead types.
- Optimizing lead performance is crucial for CRT patient outcomes.
Purpose of the Study:
- To compare the performance of BL, QL, and AFL in CRT patients.
- To evaluate technical and clinical endpoints, including reverse remodeling.
- To identify predictors of improved clinical outcomes in CRT.
Main Methods:
- Prospective evaluation of 290 CRT candidates implanted with BL, QL, or AFL.
- Follow-up for a minimum of 10 months assessing composite technical and clinical endpoints.
- Analysis included phrenic nerve stimulation, lead dislodgement, safety margins, and reverse remodeling.
Main Results:
- Technical endpoints occurred less frequently in AFL (14.3%) and QL (19.9%) compared to BL (36.3%).
- Reverse remodeling incidence was higher in AFL (64%) and QL (68%) versus BL (56%).
- No significant difference in composite clinical endpoints was observed between groups.
Conclusions:
- Quadripolar (QL) and active fixation leads (AFL) demonstrate superior technical performance over bipolar leads (BL).
- Non-BL leads were identified as a predictor of improved clinical outcomes.
- AFL excels by preventing lead dislodgement, while QL offers better phrenic nerve stimulation management.
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