Lead related complications in quadripolar versus bipolar left ventricular leads

Shasank Rijal; Jonathan Wolfe; Rohit Rattan; Asad Durrani; Andrew D Althouse; Oscar C Marroquin; Sandeep Jain; Suresh Mulukutla; Samir Saba

doi:10.1016/j.ipej.2016.10.008

Lead related complications in quadripolar versus bipolar left ventricular leads

Indian Pacing Electrophysiol J. 2017 Jan-Feb;17(1):3-7. doi: 10.1016/j.ipej.2016.10.008. Epub 2016 Oct 24.

Authors

Shasank Rijal¹, Jonathan Wolfe¹, Rohit Rattan¹, Asad Durrani¹, Andrew D Althouse¹, Oscar C Marroquin¹, Sandeep Jain¹, Suresh Mulukutla¹, Samir Saba²

Affiliations

¹ Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
² Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. Electronic address: sabas@upmc.edu.

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.

Conclusion: 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.

Keywords: Bipolar; Cardiac resynchronization therapy; Complications; Left ventricular lead; Quadripolar.