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Maximization of interventricular conduction time by means of quadripolar leads for cardiac resynchronization therapy

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Abstract

Purpose

Identifying the left ventricular (LV) site associated with the maximum spontaneous interventricular conduction time (right ventricle (RV)-to-LV interval) has proved to be an effective strategy for optimal LV pacing site selection in cardiac resynchronization therapy (CRT). The aim of our study was to determine whether quadripolar LV lead technology allows RV-to-LV interval maximization.

Methods

We enrolled 108 patients undergoing implantation of a CRT system using an LV quadripolar lead and 114 patients who received a bipolar lead. On implantation, the RV-to-LV interval was measured for the dipole of the bipolar leads and for each electrode of the LV lead (tip, ring 2, ring 3, ring 4).

Results

In the quadripolar group, the mean RV-to-LV interval ranged from 90 ± 33 ms (tip) to 94 ± 32 ms (R4) (p > 0.05 for all comparisons). In 55 (51%) patients, the RV-to-LV interval was > 80 ms at all electrodes, while in 27 (25%) patients, no electrodes were associated with an RV-to-LV interval > 80 ms. At least one LV pacing electrode was associated with an RV-to-LV interval > 80 ms in 62 (70%) patients with a short (36 mm) inter-electrode distance, and in 19 (95%, p = 0.022) of those with a long distance (50.5 mm). In the bipolar group, the mean RV-to-LV interval was 72 ± 37 ms (p < 0.001 versus quadripolar). The RV-to-LV interval was > 80 ms in 44 (39%) patients (p < 0.001 versus quadripolar leads with both short and long inter-electrode distance).

Conclusions

Quadripolar leads allow RV-to-LV interval maximization. An optimal RV-to-LV interval seems achievable in the majority of patients, especially if the leads present a long inter-electrode distance.

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Authors and Affiliations

  1. Clinica Mediterranea, Via Orazio 2, 80122, Naples, Italy

    Giuseppe Stabile & Assunta Iuliano

  2. Ospedale dei Colli-Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy

    Valter Bianchi & Antonio D’Onofrio

  3. Clinica Montevergine, Via Mario Malzoni, 5, 83013, Mercogliano, AV, Italy

    Francesco Solimene & Francesco Urraro

  4. Fondazione di Ricerca e Cura Giovanni Paolo II, Largo Agostino Gemelli, 1, 86100, Campobasso, Italy

    Quintino Parisi

  5. Ospedale Carlo Poma, Str. Lago Paiolo, 10, 46100, Mantova, Italy

    Patrizia Pepi

  6. Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy

    Mario Bocchiardo

  7. Clinica San Michele, Via Appia 171, 81024, Maddaloni, CE, Italy

    Antonio De Simone

  8. Boston Scientific Italia, Viale Enrico Forlanini, 23, 20134, Milan, Italy

    Roberto Ospizio

Authors
  1. Giuseppe Stabile
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  2. Valter Bianchi
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  3. Francesco Solimene
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  4. Assunta Iuliano
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  5. Quintino Parisi
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  6. Patrizia Pepi
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  7. Mario Bocchiardo
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  8. Francesco Urraro
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  9. Antonio De Simone
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  10. Roberto Ospizio
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  11. Antonio D’Onofrio
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Corresponding author

Correspondence to Giuseppe Stabile.

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Conflict of interest

Roberto Ospizio is an employee of Boston Scientific Italia, no other conflict of interest exists.

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Stabile, G., Bianchi, V., Solimene, F. et al. Maximization of interventricular conduction time by means of quadripolar leads for cardiac resynchronization therapy. J Interv Card Electrophysiol 50, 111–115 (2017). https://doi.org/10.1007/s10840-017-0279-x

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  • DOI: https://doi.org/10.1007/s10840-017-0279-x

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