Improved implant and postoperative lead performance in XXXX @entity1 implanted with a quadripolar left ventricular lead. A 6-month follow-up analysis from a multicenter prospective comparative study.

@entity1 @entity281 @entity162 @entity299
PURPOSE: Small single-center comparative studies suggest improved outcomes in cardiac resynchronization therapy (CRT) @entity1 implanted with a quadripolar left ventricular (LV) lead in comparison with non-quadripolar ( @entity162 ) leads. This study represents the first large multicenter prospective registry comparing implant and 6-month postoperative lead performance following @entity299 ( @entity299 ) implantation with @entity162 . METHODS: During a 39-month period, 418 consecutive @entity1 having @entity299 implantation attempts with either a quadripolar (n   =   230) or @entity162 LV lead (n   =   188) were enrolled in the registry. The primary outcome of the study was LV lead failure defined as any abnormality, excluding @entity281 , resulting in surgical lead revision or CRT termination. Additionally, operative and follow-up data were analyzed for significant difference between groups. RESULTS: Baseline characteristics of both groups were similar. In 72.9  % of quadripolar leads versus 65.0  % of @entity162 leads, the LV lead successfully engaged the predefined ideal target side branch (p   =   0.47). Implant duration and fluoroscopy times were significantly shorter when a quadripolar lead was used (p   =   0.007 and p   =   0.001, respectively). The primary end point occurred in six @entity1 (2.7  %) in the quadripolar group and in 14 @entity1 (8.0  %) in the @entity162 group (p   =   0.02). Clinically significant phrenic nerve stimulation (PNS) occurred in 4.6 vs. 14.2  % of quadripolar vs. @entity162 @entity1 , respectively (p   =   0.002); all PNS were resolved noninvasively through programming in the quadripolar group vs. 84  % in @entity162 group (p   =   0.75). The use of a @entity162 was associated with a higher risk of surgical LV lead revision (6.3 vs. 2.3  %; p   =   0.057) and a higher incidence of dislodgment (5.7 vs. 2.7  %; p   =   0.16). CONCLUSIONS: This multicenter study demonstrates that the use of a quadripolar LV lead results in significantly lower rates of lead-related problems and reduced procedural and fluoroscopic times for biventricular system implantation. This has important implications for LV pacing lead choice.
