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Quadripolar leads are associated with better results according to bipolar leads in cardiac resynchronization therapy in one-year follow-up: Multicenter, retrospective study

Year 2022, Volume 61, Issue 1, 87 - 92, 15.03.2022
https://doi.org/10.19161/etd.1086122

Abstract

Aim: In this study, we compared patients who were performed cardiac resynchronization therapy with quadripolar left ventricle lead or bipolar left ventricle lead in one-year follow-up. We investigated the relationship between the improvements of New York Heart Association classification, electrocardiography and echocardiography parameters according to lead type at one-year follow-up after CRT treatment.

Materials and Methods: In this study, 91 patients were enrolled respectively as bipolar left ventricle lead and quadripolar left ventricle lead. 40 patients are quadripolar left ventricle lead and 51 patients are bipolar left ventricle lead.

Results: After cardiac resynchronization therapy treatment in one year follow-up, patients with ≥1 NYHA improvement was 80% vs 56.8%, p=0.006 and left ventricular ejection fraction ≥5% was 77.5% vs 54.9%, p=0.031 and QRS duration 140.4±11.7 vs 151.7±19.4 ms, p=0.018 in quadripolar and bipolar left ventricle lead respectively. The univariable regression analysis revealed that left ventricular ejection fraction (OR:1.082 95%CI [1.005–1.165], p=0.037), QRS duration (OR:0.980 95%CI [0.961–0.999], p=0.038), NYHA class (OR:1.107 95%CI [0.075–0.682], p=0.008) and left ventricular ejection fraction improvement (OR:2.959 95%CI [1.083–8.086], p=0.034) were better response cardiac resynchronization therapy with quadripolar left ventricle rather than bipolar left ventricle lead.

Conclusion: Qdp LVL can be considered instead of BiP LVL to shorten QRS duration and better improve LVEF and NYHA in patients undergoing CRT in long-term follow-up

References

  • McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021.
  • Raj A, Singh AP, Nath RK, Pandit N, Aggarwal P, Thakur AK, et al. Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study. Indian pacing and electrophysiology journal 2021; 21 (3): 162-8.
  • Turakhia MP, Cao M, Fischer A, Nabutovsky Y, Sloman LS, Dalal N, et al. Reduced Mortality Associated With Quadripolar Compared to Bipolar Left Ventricular Leads in Cardiac Resynchronization Therapy. JACC Clinical electrophysiology 2016; 2 (4): 426-33.
  • Bencardino G, Di Monaco A, Russo E, Colizzi C, Perna F, Pelargonio G, et al. Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead. Circulation journal : official journal of the Japanese Circulation Society 2016; 80 (3): 613-8.
  • Maddox TM, Januzzi JL, Jr., Allen LA, Breathett K, Butler J, Davis LL, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77 (6): 772-810.
  • Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, et al. Electrocardiographic optimization techniques in resynchronization therapy. Europace 2019; 21 (9): 1286-96.
  • De Martino G, Messano L, Santamaria M, Parisi Q, Dello Russo A, Pelargonio G, et al. A randomized evaluation of different approaches to coronary sinus venography during biventricular pacemaker implants. Europace 2005; 7 (1): 73-6.
  • Turagam MK, Velagapudi P, Kocheril AG. Standardization of QRS duration measurement and LBBB criteria in CRT trials and clinical practice. Current cardiology reviews 2013; 9 (1): 20-3.
  • Moss AJ. Measurement of the QT interval and the risk associated with QTc interval prolongation: a review. Am J Cardiol 1993; 72 (6): 23b-25b.
  • Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 2019; 32 (1): 1-64.
  • Erath JW, Vamos M, Domokos D, Benz AP, Bari Z, Bogyi P, et al. Effects of implantation of quadripolar left ventricular leads on CRT response. Journal of interventional cardiac electrophysiology: an international journal of arrhythmias and pacing 2019; 55 (1): 73-81.
  • Yang M, Li X, Liang J, Asirvatham SJ, Espinosa R, Li Y, et al. Outcomes of cardiac resynchronization therapy using left ventricular quadripolar leads. Pacing and clinical electrophysiology: PACE 2018. doi: 10.1111/pace.13388.
  • Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues. Circulation journal : official journal of the Japanese Circulation Society 2011; 75 (3): 521-7.
  • Singh JP, Klein HU, Huang DT, Reek S, Kuniss M, Quesada A, et al. Left ventricular lead position and clinical outcome in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) trial. Circulation 2011; 123 (11): 1159-66.
  • Korantzopoulos P, Zhang Z, Li G, Fragakis N, Liu T. Meta-Analysis of the Usefulness of Change in QRS Width to Predict Response to Cardiac Resynchronization Therapy. Am J Cardiol 2016; 118 (9): 1368-73.

Kuadripolar sol ventrikül leadler, bir yıllık takipte kardiyak resenkronizasyon tedavisinde bipolar leadlere göre daha iyi sonuçlarla ilişkilidir: Çok merkezli, retrospektif çalışma

Year 2022, Volume 61, Issue 1, 87 - 92, 15.03.2022
https://doi.org/10.19161/etd.1086122

Abstract

Amaç: Bu çalışmada, bir yıllık takipte kuadripolar sol ventrikül leadi veya bipolar sol ventrikül leadi ile kardiyak resenkronizasyon tedavisi uygulanan hastaları karşılaştırdık. Kardiyak resenkronizasyon tedavisi sonrası NYHA (New York Heart Association) sınıflaması, elektrokardiyografi ve ekokardiyografi parametrelerinin lead tipine göre bir yıllık takipteki düzelmelerini araştırdık.

Gereç ve Yöntem: Bu çalışmada 91 hasta sırasıyla bipolar sol ventrikül lead'i ve kuadripolar sol ventrikül lead'i olarak kaydedildi. 40 hasta kuadripolar sol ventrikül lead'i ve 51 hasta bipolar sol ventrikül leadi takıldı.

Bulgular: Bir yıllık takipte kardiyak resenkronizasyon tedavisi tedavisinden sonra, ≥1 NYHA iyileşmesi olan hastalar %80'e karşı %56,8, p=0.006 ve sol ventrikül ejeksiyon fraksiyonu ≥%5 %77,5’ya karşılık %54,9, p=0.031 ve QRS süresi 140,4 idi. ±11,7 vs 151,7±19,4 p=0.018 ms, sırasıyla kuadripolar ve bipolar sol ventrikül leadinde. Tek değişkenli regresyon analizi, sol ventrikül ejeksiyon fraksiyonu (OR:1.082 %95 CI [1.005–1.165], p=0.037), QRS süresi (OR:0.980 %95 CI [0.961–0.999], p=0.038), NYHA sınıfı (OR:1.107 %95 GA [0.075-0.682], p=0.008) ve sol ventrikül ejeksiyon fraksiyonu iyileşmesi (OR:2.959 %95 CI [1.083-8.086], p=0.034) kardiyak kardiyak resenkronizasyon tedavisi uygulanan ve kuadripolar sol ventrikül leadi uygulananlarda bipolar sol ventrikül leadi takılanlara göre daha iyi yanıtla ilişkili bulundu.

Sonuç: Kardiyak resenkronizasyon tedavisi uygulanan hastalarda uzun dönem takipte QRS süresini kısaltmak, sol ventrikül ejeksiyon fraksiyonunu ve NYHA'yı daha iyi iyileştirmek için bipolar sol ventrikül leadi yerine kuadripolar sol ventrikül leadi seçilmelidir.

References

  • McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021.
  • Raj A, Singh AP, Nath RK, Pandit N, Aggarwal P, Thakur AK, et al. Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study. Indian pacing and electrophysiology journal 2021; 21 (3): 162-8.
  • Turakhia MP, Cao M, Fischer A, Nabutovsky Y, Sloman LS, Dalal N, et al. Reduced Mortality Associated With Quadripolar Compared to Bipolar Left Ventricular Leads in Cardiac Resynchronization Therapy. JACC Clinical electrophysiology 2016; 2 (4): 426-33.
  • Bencardino G, Di Monaco A, Russo E, Colizzi C, Perna F, Pelargonio G, et al. Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead. Circulation journal : official journal of the Japanese Circulation Society 2016; 80 (3): 613-8.
  • Maddox TM, Januzzi JL, Jr., Allen LA, Breathett K, Butler J, Davis LL, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77 (6): 772-810.
  • Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, et al. Electrocardiographic optimization techniques in resynchronization therapy. Europace 2019; 21 (9): 1286-96.
  • De Martino G, Messano L, Santamaria M, Parisi Q, Dello Russo A, Pelargonio G, et al. A randomized evaluation of different approaches to coronary sinus venography during biventricular pacemaker implants. Europace 2005; 7 (1): 73-6.
  • Turagam MK, Velagapudi P, Kocheril AG. Standardization of QRS duration measurement and LBBB criteria in CRT trials and clinical practice. Current cardiology reviews 2013; 9 (1): 20-3.
  • Moss AJ. Measurement of the QT interval and the risk associated with QTc interval prolongation: a review. Am J Cardiol 1993; 72 (6): 23b-25b.
  • Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 2019; 32 (1): 1-64.
  • Erath JW, Vamos M, Domokos D, Benz AP, Bari Z, Bogyi P, et al. Effects of implantation of quadripolar left ventricular leads on CRT response. Journal of interventional cardiac electrophysiology: an international journal of arrhythmias and pacing 2019; 55 (1): 73-81.
  • Yang M, Li X, Liang J, Asirvatham SJ, Espinosa R, Li Y, et al. Outcomes of cardiac resynchronization therapy using left ventricular quadripolar leads. Pacing and clinical electrophysiology: PACE 2018. doi: 10.1111/pace.13388.
  • Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues. Circulation journal : official journal of the Japanese Circulation Society 2011; 75 (3): 521-7.
  • Singh JP, Klein HU, Huang DT, Reek S, Kuniss M, Quesada A, et al. Left ventricular lead position and clinical outcome in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) trial. Circulation 2011; 123 (11): 1159-66.
  • Korantzopoulos P, Zhang Z, Li G, Fragakis N, Liu T. Meta-Analysis of the Usefulness of Change in QRS Width to Predict Response to Cardiac Resynchronization Therapy. Am J Cardiol 2016; 118 (9): 1368-73.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Research Articles
Authors

Ramazan GUNDUZ This is me (Primary Author)
Manisa City Hospital Department of Cardiology, Manisa, Turkiye
0000-0001-7133-4604
Türkiye


Songul USALP This is me
Sehit Profesor Ilhan Varank Education and Reaearch Hospital Department of Cardiology, Istanbul, Turkiye
0000-0001-9572-5431
Türkiye

Publication Date March 15, 2022
Application Date October 4, 2021
Acceptance Date February 14, 2022
Published in Issue Year 2022, Volume 61, Issue 1

Cite

Vancouver Gunduz R. , Usalp S. Quadripolar leads are associated with better results according to bipolar leads in cardiac resynchronization therapy in one-year follow-up: Multicenter, retrospective study. Ege Tıp Dergisi. 2022; 61(1): 87-92.