The Use of a Quadripolar Left Ventricular Lead Increases Successful Implantation Rates in Patients with Phrenic Nerve Stimulation and/or High Pacing Thresholds Undergoing Cardiac Resynchronisation Therapy with Conventional Bipolar Leads

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Journal Title, Volume, Page: 
Indian Pacing Electrophysiol J. 2013 Mar;13(2):58-65. Epub 2013 Mar 7
Year of Publication: 
Marc-Alexander Ohlow
Bernward Lauer
Michele Brunelli
Yunis Daralammouri
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus. Palestine
Christoph Geller
Preferred Abstract (Original): 

Background: Phrenic nerve stimulation (PNS) and high pacing thresholds (HPT) hinder biventricular stimulation in patients (pts) undergoing cardiac resynchronization therapy (CRT). A new quadripolar left ventricular (LV) lead (Quartet 1458Q, St. Jude Medical) with increased number of pacing configuration, might overcome this problem.

Methods: All consecutive pts in whom a standard bipolar lead intraoperatively resulted in PNS and/or HPT (≥4.00V/1mV), received, during the same implant, a quadripolar LV lead. Aim of the study was to evaluate acute and short term outcome.                                          

Results: 26 pts [24 (92%) male, mean age 74±6 years)] with PNS (22 pts; 85%) and HPT (4 pts; 15%) were included. Permanent right ventricular pacing was the reason for broad QRS complex in 4 (15%) pts, whereas all other pts had a left bundle branch block. Severely symptomatic (NYHA Class ≥3) heart failure with reduced ejection fraction (EF 31±9%) was mostly caused by ischemic  heart disease (14 pts; 54%). Idiopathic dilated cardiomyopathy and valvular heart disease were diagnosed in 6 (23%) pts each. In most (24/26, 92%) pts the use of the Quartet lead led to successful biventricular pacing due to a significant reduction in intraoperative pacing threshold (5.2V/1.0ms vs. 1.4V/0.8ms; p=0.03), which was maintained (1.2V/0.7ms) at follow-up. PNS never represented reason for failed LV pacing, neither

The_Use_of_a_Quadripolar_Left_Ventricular_Lead_Increases_Successful_Implantation_Rates_in_Patients_with_Phrenic_Nerve_Stimulation_andor_High_Pacing_Thresholds_Undergoing_Cardiac_Resynchronisation.pdf309.56 KB