Cardiac Resynchronization Therapy Using Quadripolar Versus Non-Quadripolar Left Ventricular Leads Programmed to Biventricular Pacing With Single-Site Left Ventricular Pacing: Impact on Survival and Heart Failure Hospitalization

Abstract

Background: In cardiac resynchronization therapy (CRT), quadripolar (QUAD) left ventricular (LV) leads are less prone to postoperative complications than non-QUAD leads. Some studies have suggested better clinical outcomes.

Methods and results: Clinical events were assessed in 847 patients after CRT-pacing or CRT-defibrillation using either QUAD (n=287) or non-QUAD (n=560), programmed to single-site site LV pacing. Over a follow-up period of 3.2 years (median [interquartile range, 1.90-5.0]), QUAD was associated with a lower total mortality (adjusted hazard ratio [aHR]: 0.32, 95% confidence interval [CI], 0.20-0.52), cardiac mortality (aHR: 0.36, 95% CI, 0.20-0.65), and heart failure (HF) hospitalization (aHR: 0.62, 95% CI, 0.39-0.99), after adjustment for age, sex, New York Heart Association class, HF etiology, device type (CRT-pacing or CRT-defibrillation), comorbidities, atrial rhythm, medication, left ventricular ejection fraction, and creatinine. Death from pump failure was lower with QUAD (aHR: 0.33; 95% CI, 0.18-0.62), but no group differences emerged with respect to sudden cardiac death. There were no differences in implant-related complications. Re-interventions for LV displacement or phrenic nerve stimulation, which were lower with QUAD, predicted total mortality (aHR: 1.68, 95% CI, 1.11-2.54), cardiac mortality (aHR: 2.61, 95% CI, 1.66-4.11) and HF hospitalization (aHR: 2.09, 95% CI, 1.22-3.58).

Conclusions: CRT using QUAD, programmed to biventricular pacing with single-site LV pacing, is associated with a lower total mortality, cardiac mortality, and HF hospitalization. These trends were observed for both CRT-defibrillation and CRT-pacing, after adjustment for HF cause and other confounders. Re-intervention for LV lead displacement or phrenic nerve stimulation was associated with worse outcomes.

Keywords: arrhythmia; bipolar lead; cardiac resynchronization therapy; heart failure; quadripolar lead; sudden cardiac death.

Figure 1

Clinical outcomes according to lead type. Kaplan–Meier survival curves for clinical outcomes according to device and lead type. HF indicates heart failure; QUAD, quadripolar lead.

Figure 2

Clinical outcomes according to device and lead type. Kaplan–Meier survival curves for clinical outcomes according to device and lead type. aHR indicates adjusted hazard ratio; C.I., confidence interval; CRT‐D, cardiac resynchronization therapy‐defibrillation; CRT‐P, cardiac resynchronization therapy‐pacing; HF, heart failure; QUAD, quadripolar lead.

Figure 3

Mode of death according to lead type. Kaplan–Meier survival curves for death from pump failure or sudden cardiac death (SCD) according to lead type. aHR indicates adjusted hazard ratio; C.I., confidence interval; QUAD, quadripolar lead.

Figure 4

Reinterventions for left ventricular lead displacement or phrenic nerve stimulation. Kaplan–Meier survival curves of re‐interventions for left ventricular (LV) lead displacement or phrenic nerve stimulation (PNS) after device implantation using quadripolar (QUAD) or non‐QUAD leads. aHR indicates adjusted hazard ratio.