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Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study
Author(s) -
ZIACCHI MATTEO,
SAPORITO DAVIDE,
ZARDINI MARCO,
LUZI MARIO,
QUARTIERI FABIO,
MORGAGNI GIANLUIGI,
DE MARIA ELIA,
BERTINI MATTEO,
CARINCI VALERIA,
BORIANI GIUSEPPE,
BIFFI MAURO
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12792
Subject(s) - medicine , lead (geology) , cardiology , heart failure , cardiac resynchronization therapy , adverse effect , ventricular remodeling , ejection fraction , geomorphology , geology
Background To understand the impact of a quadripolar left ventricular (LV) lead on reverse remodeling and phrenic nerve stimulation (PNS) in congestive heart failure patients treated by cardiac resynchronization therapy at 8‐month follow‐up (FU). Methods One hundred and fifty‐eight patients received an LV Medtronic Performa lead (Medtronic Inc., Minneapolis, MN, USA) and were reevaluated at FU by echocardiography and measurement of electrical parameters. Results A targeted LV lead placement was achieved in 140 (89%) patients. Super responders and responders were 76 (50%) and 26 (18%), respectively, at FU; seven (4%) died and 13 (8%) were hospitalized for any cause. Nonischemic etiology was the only independent predictor of reverse remodeling. The configurations available only with the Performa leads reduced PNS occurrence at 8 V@0.4 ms from 43 (27%) to 14 (9%) of patients at implantation, and from 44 (28%) to 19 (12%) at last FU, compared to configurations available with bipolar leads. Patients with detectable PNS had >10/16 pacing configurations with a PNS safety margin >2 V both at implantation and at FU. During FU 16 (10%) patients had an adverse event possibly related to the lead or to modification of the underlying heart disease but 99% of these events were fixed by reprogramming of the pacing vector. Conclusions Performa Lead enables an increased capability to achieve a targeted lead positioning in the broad clinical scenario of large‐ and small‐volume implanting centers, with a relevant impact on the occurrence of reverse remodeling compared to literature data. The enhanced management of PNS resulted in a dislodgement rate of only 1%.