| PurposeAt present,with the advent of left ventricular quadrupolar lead,left ventricular multipoint pacing has been realized,which increases the pacemaker site compared with the left ventricular bipolar lead,and can achieve pacing in two sites of the left ventricle,capture a wider range of ventricular muscles and improve the synchrony of left ventricle to make the contraction coordinated.The purpose of this study was to investigate whether left ventricular quadrupolar lead was superior to left ventricular bipolar lead in reducing perioperative complications,improving cardiac function,improving hemodynamics,and CRT response rate,etc.MethodFrom August 2016 to October 2017,20 patients with chronic congestive heart failure were accepted into the First Affiliated Hospital of Kunming Medical University,who conformed to the 2016 ESC guidelines CRTI indications,and had been successfully implanted with CRT-P/D.There were 17 cases of dilated cardiomyopathy(DCM)and 3 cases of ischemic cardiomyopathy(ICM)included.Those who met the inclusion criteria were enrolled into the study.The best drug treatment and implantation of left ventricular quadrupolar lead was performed in 10 patients as the study group,that was the quadrupolar lead group.According to baseline data,and strictly complying to age,gender,comorbidity,NYHA classification,optimal drug treatment and QRS wave width were a 1:1 matched for 10 patients with left ventricular bipolar as the control group,that was the bipolar lead group.After successful matching,we started clinical research and clinical follow-up.In the study group,MPP function was turned on after operation.After monitoring of cardiac ultrasound indices and electrocardiogram QRS wave duration,both groups were set for the AVD and VVD corresponding to the AVVTI,LVEF maximum,reference E,A peak separation,MRA minimum and narrowest QRS wave duration,and the optimized AVD and VVD.Follow-up was performed at the 1st,3rd,and 6th month after surgery.Perioperative complications,QRS wave duration,and cardiac function were compared between the two groups.Aortic valve velocity time integral(AVVTI);conventional hyper cardiac indices(left ventricular end-diastolic diameter,left ventricular ejection fraction),and cardiac synchronizing indices(Ts-SD12:standard deviation of left ventricular 12-segment peak time,IVMD:interventricular mechanical delay time)were evaluated under echocardiography.At the same time NYHA classification of cardiac function,6-minute walk distance,Minnesota heart failure quality of life(MN)score table and other indicators were followed up.Our aim was to clarify whether the left ventricular quadrupolar lead was better than the left ventricular bipolar lead in reducing perioperative complications,improving cardiac function,improving acute hemodynamics,cardiac synchronization indicators,improving CRT response rate.The SPSS 22.0 statistical software package was used to analyze the data.The difference was statistically significant when P<0.05.Result1.In the study,the average follow-up duration was 7.311.2(months).10 patients implanted with left ventricular quadrupolar lead(study group)and 10 with left ventricular bipolar lead(control group).The QRS duration was significantly shorter in the quadrupolar lead group than in the bipolar lead group after operation(127.1±5.9ms vs 135.4±9.29ms,P=0.029),and the difference was statistically significant.2.For cardiac synchronization indices,intraventricular synchronization was evaluated with the standard deviation of left intraventricular 12-segment peak time(Ts-SD12).and the quadruple lead group was superior to the bipolar lead group(92.00±12.90vs105.00±8.41,P=0.011).Interventricular synchrony was assessed by with interventricular mechanical delay time(IVMD),and there was no significant difference between the two groups(71.5±9.53ms vs 73.4±8.4 ms,P=0.643).3.The improvement of left ventricular ejection fraction in quadruple lead group was better than that of bipolar lead group(37.4±4.5%vs 32.1±4.38%,P=0.016).For acute hemodynamics indices,the aortic valve velocity time integral scores 22.2±2.9 cm vs.19.8±8.4 cm,P=0.032)was improved more significantly in the quadruple lead group;differences in left ventricular end-diastolic diameter(65.22±2.2 mm vs 63.1 ±3.34 mm,P=0.115)between the two groups showed no statistical significances.4.The quadrupolar lead group was superior to the bipolar lead group in improvement of cardiac function grading(1.9±0.31vs2.5±0.52,P=0.006).For 6-minute walk test,the improvement in the quadrupolar lead group was even more pronounced(406.5±20.14m vs 379.5±24.99m,P=0.016).Minnesota Scores of life quality of patients with heart failure(15.7±6.07 vs17.6±6.44,P=0.506)showed no significant differences between the two groups.5.For the follow-up 6 months after operation,there were 8 cases(80%)of CRT response in the quadrupolar lead group,and 6 cases(60%)of CRT response in the bipolar lead group.There was no significant differences between the two groups P>0.05),but the reaction rate in the quadrupolar lead group was higher than that of the bipolar lead group.In terms of CRT reactivity,the left ventricular quadrupolar lead group was not inferior to the bipolar lead group.6.The sacral nerve stimulation occurred in 2 cases of the quadrupolar lead group,and the threshold value increased in 1 case.All of them were resolved by changing the pacing vectors.The sacral nerve stimulation occurred in 1 case of the bipolar lead group and the threshold value increased in 1 case.Both of them were resolved by Surgeon.Because the sample size was too small,no statistical analysis was performed.However,the quadrupolar lead group was resolved by program-controlled change of the pacing vector and was superior to the bipolar lead group.ConclusionLeft ventricular quadrupolar lead in cardiac resynchronization therapy in the treatment of chronic heart failure patients could improve cardiac function,left ventricular synchronization and shorten the QRS wave duraion,with CRT response rate not inferior to the left ventricular bipolar lead. |
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