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Impact of quadripolar LV leads on heart failure hospitalization rates among patients implanted with CRT-D: data from the Israeli ICD Registry

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Abstract

Background

Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF); however, a third of patients are non-responders. The development of quadripolar left ventricular (LV) lead was shown, mainly in single manufactures’ registry, to improve LV remodeling and overall mortality. However, limited reports exist on the impact of quadripolar LV leads on HF hospitalization rates in real-life cohorts. We evaluated the clinical outcomes associated with quadripolar LV leads in a large nation-wide registry including all patients implanted with a cardiac resynchronization therapy with defibrillator (CRT-D).

Methods

Between July 2010 and October 2016, 2913 consecutive patients were implanted with a CRT-D and all were prospectively enrolled in the Israeli ICD Registry. Quadripolar LV leads were implanted in 973 (33.4%) patients during this period, and their clinical outcomes were compared to CRT-D recipients implanted with a bipolar LV lead. Primary endpoint was HF hospitalization rate.

Results

Quadripolar leads were implanted more in patients with non-ischemic cardiomyopathy and for primary prevention indication and less in post-infarction patients and for secondary prevention of sudden death. Longer QRS duration was observed with quadripolar leads (147 ± 23 vs 143 ± 25; p < 0.001). Outcome event rate for 100 patient years revealed no difference in HF hospitalization rates between bipolar and quadripolar LV leads. Quadripolar lead implant led to lower cardiac mortality, with no influence on overall mortality. Multivariate analysis revealed no significant differences in study endpoints between bipolar and quadripolar LV leads.

Conclusion

In a large real-life registry, implantation of quadripolar LV leads in patients with CRT-D did not influence HF hospitalization rates.

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Acknowledgements

The authors thank Mrs. Michal Einhorn and Mr. Nir Shlomo from the Israeli Association for Cardiovascular Trials (IACT) for their assistance in the data retrieval and statistical analysis.

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Authors and Affiliations

  1. Department of Cardiology, Tel-Aviv Medical Center, Tel Aviv, Israel

    Eran Leshem & Yoav Michowitz

  2. Cardiovascular Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Boston, MA, 02215, USA

    Eran Leshem

  3. Cardiology Department, Rambam Medical Center, Haifa, Israel

    Mahmoud Suleiman & Avishag Laish-Farkash

  4. Cardiology Department, Soroka Medical Center, Beer Sheva, Israel

    Moti Haim

  5. Cardiology Department, Edith Wolfson Medical Center, Holon, Israel

    Michael Geist

  6. Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    David Luria

  7. Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel

    Michael Glikson & Ilan Goldenberg

  8. IACT-Neufeld Cardiac Research Institute, Tel Hashomer, Israel

    Ilan Goldenberg

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  1. Eran Leshem
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  2. Mahmoud Suleiman
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  3. Avishag Laish-Farkash
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  4. Moti Haim
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on behalf of the Israeli Working Group of Pacing and Electrophysiology

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Correspondence to Eran Leshem.

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The authors declare that they have no competing interests.

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All authors take full responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Leshem, E., Suleiman, M., Laish-Farkash, A. et al. Impact of quadripolar LV leads on heart failure hospitalization rates among patients implanted with CRT-D: data from the Israeli ICD Registry. J Interv Card Electrophysiol 51, 5–12 (2018). https://doi.org/10.1007/s10840-017-0305-z

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  • DOI: https://doi.org/10.1007/s10840-017-0305-z

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