• Jonathan M Behar, Julian Bostock, Adrian Po Zhu Li, Hui Men Selina Chin, Stephen Jubb, Edward Lent, James Gamble, Paul W X Foley, Tim R Betts, Christopher Aldo Rinaldi, and Neil Herring.
• Department of Imaging Sciences and Bioengineering, BHF Centre of Research Excellence, The Rayne Institute, London, UK.
• J. Cardiovasc. Electrophysiol. 2015 May 1; 26 (5): 540-6.

IntroductionCardiac resynchronization therapy (CRT) using quadripolar left ventricular (LV) leads provides more pacing vectors compared to bipolar leads. This may avoid phrenic nerve stimulation (PNS) and allow optimal lead placement to maximize biventricular pacing. However, a long-term improvement in patient outcome has yet to be demonstrated.MethodsA total of 721 consecutive patients with conventional CRTD criteria implanted with quadripolar (n = 357) or bipolar (n = 364) LV leads were enrolled into a registry at 3 UK centers. Lead performance and mortality was analyzed over a 5-year period.ResultsPatients receiving a quadripolar lead were of similar age and sex to those receiving a bipolar lead, although a lower proportion had ischemic heart disease (62.6% vs. 54.1%, P = 0.02). Both groups had similar rates of procedural success, although lead threshold, impedance, and procedural radiation dose were significantly lower in those receiving a quadripolar lead. PNS was more common in those with quadripolar leads (16.0% vs. 11.6%, P = 0.08), but was eliminated by switching pacing vector in all cases compared with 60% in the bipolar group (P < 0.001). Furthermore, LV lead displacement (1.7% vs. 4.6%, P = 0.03) and repositioning (2.0% vs. 5.2%, P = 0.03) occurred significantly less often in those with a quadripolar lead. All-cause mortality was also significantly lower in the quadripolar compared to bipolar lead group in univariate and multivariate analysis (13.2% vs. 22.5%, P < 0.001).ConclusionsIn a large, multicenter experience, the use of quadripolar LV leads for CRT was associated with elimination of PNS and lower overall mortality. This has important implications for LV pacing lead choice.© 2015 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals, Inc.

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