Retrospective Analysis Of Application Of The Quadripolar Left Ventricular Lead In19Cases

Objective:The purpose of this study was to evaluate the outcomes of19patients who received cardiac resynchronization therapy (CRT) with a quadripolar left ventricular (LV) lead implanted in our hospital.Methods:We studied19consecutive heart failure patients from March2014to Feb2015, following successful implantation of a quadripolar LV lead. During implantation, we acquired the following data:1) the characteristics of LV lateral vascular and its tributaries using coronary venography;2) the incidence of phrenic nerve stimulation(PNS) or high pacing threshold (HPT) during implantation;3) the final position of pacing vector. During1-12months follow-up, clinical date were collected as follows:1) the improvement of cardiac function such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), QRS width, and NYHA class;2) the incidence of LV lead associated complications such as LV lead dislocation, PNS, and HPT.Results:19patients were selected in our study (12men,7female,65.9±8.8years). The implantation success rate of those whose lateral blood vessel was suitable to the quadripolar left ventricular lead reached to100%. In16cases the LV lead was implanted at the optimal pacing site. The LV lead were successfully implanted at the first time in18cases. PNS was reported in7cases and HPT in2cases during implantation, which were all overcame by reprogramming of the device.1patient need lead reposition in another target vessel for either PNS or HPT were appeared in all the ten vectors in the first target vessel. After a median follow-up of6months, LVEF improved [(38.7±8.6) vs (29.8±4.5)%, p<0.05] and QRS duration reduced [(118.7±9.8) vs (159.5±20.6) ms, p<0.05]. The threshold of LV lead remained stable [(1.2±0.7) vs (1.1±0.6) V, p>0.05]. LV lead dislocation happened in one case (5.3%) at1-month follow-up. No other dislocation of LV lead, PNS or HPT was observed.Conclusions:The quadripolar LV lead would try out to reduce LV lead associated complications like HPT and PNS, avoid apical pacing and improve heart function, which proved to be an important option in CRT patients whose target vessel met the requirement of the quadripolar LV lead.