Single-center experience of a quadripolar pacing lead for cardiac resynchronization therapy

  • Antonello Vado
  • Endrj Menardi
  • Guido Rossetti
  • Gianpaolo Ballari
  • Mauro Feola
  • Marco Bobbio



Recent studies have shown that a quadripolar left ventricular (LV) lead can result in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and on medium-term follow-up in cardiac resynchronization therapy (CRT). We evaluated the outcomes of CRT patients in whom a quadripolar LV lead was implanted in our institution.


We studied 45 consecutive heart failure patients (75 % men; age, 70.3 ± 9.0 years) following successful implantation of a quadripolar LV lead. Demographic and clinical data were collected preoperatively, and patients were followed up for 18.9 months.


The implantation success rate was 100 %. Mean overall duration was 100.1 ± 34.6 min, and X-ray exposure time was 13.20 ± 13.5 min. The most distal effective pacing site was used as the final pacing configuration in all patients. Acute dislodgment requiring reoperation occurred before discharge in three cases (6.6 %). Six patients (13 %) suffered PNS during follow-up; we solved this problem by changing the stimulation vector. Three months after implantation, a mean of six out of ten effective sites (threshold <2.5 V at 1.5 ms, no PNS) per patient was recorded.


Over the relatively long term, the quadripolar LV lead was associated with excellent pacing thresholds and low rates of dislocation and PNS.


Cardiac resynchronization therapy Quadripolar left ventricular lead Phrenic nerve stimulation 



Cardiac resynchronization therapy


Coronary sinus


Left ventricular


Phrenic nerve stimulation


  1. 1.
    Bristow, M. R., Saxon, L. A., Boehmer, J., et al. (2004). Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350, 2140–2150.PubMedCrossRefGoogle Scholar
  2. 2.
    Cleland, J. G., Daubert, J. C., Erdmann, E., et al. (2005). Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352, 1539–1549.PubMedCrossRefGoogle Scholar
  3. 3.
    Epstein, A. E., DiMarco, J. P., Ellenbogen, K. A., et al. (2008). ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation, 117, e350–e408.PubMedGoogle Scholar
  4. 4.
    Shetty, A. K., Duckett, S. G., Bostock, J., et al. (2011). Initial single-center experience of a quadripolar pacing lead for cardiac resynchronization therapy. Pacing and Clinical Electrophysiology, 34, 484–489.PubMedCrossRefGoogle Scholar
  5. 5.
    Sperzel, J., Danschel, W., Gutleben, K. J., et al. (2012). First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead. Europace, 14, 365–372.PubMedCrossRefGoogle Scholar
  6. 6.
    Forleo, G. B., Della Rocca, D. G., Papavasileiou, L. P., Molfetta, A. D., Santini, L., & Romeo, F. (2011). Left ventricular pacing with a new quadripolar transvenous lead for CRT: early results of a prospective comparison with conventional implant outcomes. Heart Rhythm, 8, 31–37.PubMedCrossRefGoogle Scholar
  7. 7.
    Burger, H., Schwarz, T., Ehrlich, W., Sperzel, J., Kloevekorn, W. P., & Ziegelhoeffer, T. (2011). New generation of transvenous left ventricular leads—first experience with implantation of multipolar left ventricular leads. Experimental and Clinical Cardiology, 16, 23–26.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Della Rocca, D. G., Forleo, G. B., Santini, L., & Romeo, F. (2012). Without a quadripolar left ventricular lead you don't succeed: a challenging case of phrenic nerve stimulation. International Journal of Cardiology, 155, e37–e38.PubMedCrossRefGoogle Scholar
  9. 9.
    Mehta, P. A., Shetty, A. K., Squirrel, M., Bostock, & Rinaldi, C. A. (2012). Elimination of phrenic nerve stimulation occurring during CRT: follow-up in patients implanted with a novel quadripolar pacing lead. Journal of Interventional Cardiac Electrophysiology, 33, 43–49.PubMedCrossRefGoogle Scholar
  10. 10.
    Forleo, G. B., Mantica, M., Di Biase, L., et al. (2012). Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead: early results of a prospective multicenter study. Heart Rhythm, 9, 1822–1828.PubMedCrossRefGoogle Scholar
  11. 11.
    Butter, C., Auricchio, A., Stellbrink, C., et al. (2001). Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation, 104, 3026–3029.PubMedCrossRefGoogle Scholar
  12. 12.
    Gurevitz, O., Nof, E., Carasso, S., et al. (2005). Programmable multiple pacing configurations help to overcome high left ventricular pacing thresholds and avoid phrenic nerve stimulation. Pacing and Clinical Electrophysiology, 28, 1255–1259.PubMedCrossRefGoogle Scholar
  13. 13.
    Biffi, M., Schau, T., Moeller, V., et al. (2009). Phrenic stimulation: a challenge for cardiac resynchronization therapy. Circulation. Arrhythmia and Electrophysiology, 2, 402–410.PubMedCrossRefGoogle Scholar
  14. 14.
    Seifert, M., Schau, T., Moeller, V., Neuss, M., Meyhoefer, J., & Butter, C. (2010). Influence of pacing configurations, body mass index, and position of coronary sinus lead on frequency of phrenic nerve stimulation and pacing thresholds under cardiac resynchronization therapy. Europace, 12, 961–967.PubMedCrossRefGoogle Scholar
  15. 15.
    Moss, A. J., Hall, W. J., Cannom, D. S., Klein, H., Brown, M. W., Daubert, J. P., et al. (2009). Cardiac resynchronization therapy for the prevention of heart-failure events. New England Journal of Medicine, 361, 1329–1338.PubMedCrossRefGoogle Scholar
  16. 16.
    Tang, A. S. L., Wells, G. A., Talajic, M., Arnold, M. O., Sheldon, R., Connolly, S., et al. (2010). Cardiac-resynchronization therapy for mild-to-moderate heart failure. New England Journal of Medicine, 363, 2385–2395.PubMedCrossRefGoogle Scholar
  17. 17.
    Linde, C., Abraham, W. T., Gold, M. R., St John Sutton, M., Ghio, S., Daubert, C., et al. (2008). Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. Journal of the American College of Cardiology, 52, 1834–1843.PubMedCrossRefGoogle Scholar
  18. 18.
    Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352, 1539–1549.PubMedCrossRefGoogle Scholar
  19. 19.
    Knight, B. P., Desai, A., Coman, J., Faddis, M., & Yong, P. (2004). Long-term retention of cardiac resynchronization therapy. Journal of the American College of Cardiology, 44, 72–77.PubMedCrossRefGoogle Scholar
  20. 20.
    Ailawadi, G., Lapar, D. J., Swenson, B. R., et al. (2010). Surgically placed left ventricular leads provide similar outcomes to percutaneous leads in patients with failed coronary sinus lead placement. Heart Rhythm, 7, 619–625.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Merchant, F. M., Heist, E. K., McCarty, D., et al. (2010). Impact of segmental left ventricle lead position on cardiac resynchronization therapy outcomes. Heart Rhythm, 7, 639–644.PubMedCrossRefGoogle Scholar
  22. 22.
    Lin, G., Anavekar, N. S., Webster, T. L., Rea, R. F., Hayes, D. L., & Brady, P. A. (2009). Long-term stability of endocardial left ventricular pacing leads placed via the coronary sinus. Pacing and Clinical Electrophysiology, 32, 1117–1122.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Antonello Vado
    • 1
  • Endrj Menardi
    • 1
  • Guido Rossetti
    • 1
  • Gianpaolo Ballari
    • 1
  • Mauro Feola
    • 2
  • Marco Bobbio
    • 3
  1. 1.EP LabOspedale S.Croce e CarleCuneoItaly
  2. 2.Unità scompenso cardiaco, ASL CN1CuneoItaly
  3. 3.Cardiology DepartmentOspedale S.Croce e CarleCuneoItaly

Personalised recommendations