Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead

Gianluigi Bencardino; Antonio Di Monaco; Eleonora Russo; Cristian Colizzi; Francesco Perna; Gemma Pelargonio; Maria Lucia Narducci; Francesca Augusta Gabrielli; Gaetano Antonio Lanza; Antonio Giuseppe Rebuzzi; Filippo Crea

doi:10.1253/circj.CJ-15-0932

Arrhythmia/Electrophysiology

Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead

Gianluigi Bencardino, Antonio Di Monaco, Eleonora Russo, Cristian Colizzi, Francesco Perna, Gemma Pelargonio, Maria Lucia Narducci, Francesca Augusta Gabrielli, Gaetano Antonio Lanza, Antonio Giuseppe Rebuzzi, Filippo Crea

Author information

Gianluigi Bencardino
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Antonio Di Monaco
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Eleonora Russo
Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS
Cristian Colizzi
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Francesco Perna
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Gemma Pelargonio
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Maria Lucia Narducci
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Francesca Augusta Gabrielli
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Gaetano Antonio Lanza
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Antonio Giuseppe Rebuzzi
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
Filippo Crea
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart

Keywords: Cardiac resynchronization therapy, Heart failure, Mortality, Multipolar pacing, Quadripolar lead

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2016 Volume 80 Issue 3 Pages 613-618

DOI https://doi.org/10.1253/circj.CJ-15-0932

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Abstract

Background:Not all heart failure (HF) patients benefit from cardiac resynchronization therapy (CRT). We assessed whether choosing the site of left ventricular (LV) pacing by a quadripolar lead may improve response to CRT.Methods and Results:We prospectively randomized 23 patients with HF (67±11 years; 21 males) to CRT with a quadripolar LV lead (group 1, with the LV pacing site chosen on the basis of QRS shortening using simultaneous biventricular pacing), and 20 patients (71±6 years; 16 males) to a bipolar LV lead (group 2, with devices programmed with a conventional tip-to-ring configuration). New York Heart Association (NYHA) class and LV ejection fraction (EF) by 2D echocardiography were assessed at baseline and after 3 months. The baseline EF was not different between the 2 groups (25±6% group 1 vs. 27±3% group 2; P=0.22), but after 3 months EF was higher in group 1 (35±13% group 1 vs. 31±4% group 2; P<0.001). A reduction in at least 1 NYHA class at 3 months was observed in 22 (96%) and 12 (60%) of group 1 and group 2 patients, respectively (P<0.05).Conclusions:CRT with a quadripolar LV lead was associated with an improvement of EF greater than that observed in patients receiving a bipolar LV lead. In devices with a quadripolar lead, CRT programming based on the best QRS shortening is reliable and effective. (Circ J 2016; 80: 613–618)

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