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%.

Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study / Ziacchi, Matteo; Saporito, Davide; Zardini, Marco; Luzi, Mario; Quartieri, Fabio; Morgagni, Gianluigi; De Maria, Elia; Bertini, Matteo; Carinci, Valeria; Boriani, Giuseppe; Biffi, Mauro. - In: PACING AND CLINICAL ELECTROPHYSIOLOGY. - ISSN 0147-8389. - 39:3(2016), pp. 250-260. [10.1111/pace.12792]

Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study

BORIANI, Giuseppe;
2016

Abstract

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%.
2016
11-gen-2016
39
3
250
260
Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study / Ziacchi, Matteo; Saporito, Davide; Zardini, Marco; Luzi, Mario; Quartieri, Fabio; Morgagni, Gianluigi; De Maria, Elia; Bertini, Matteo; Carinci, Valeria; Boriani, Giuseppe; Biffi, Mauro. - In: PACING AND CLINICAL ELECTROPHYSIOLOGY. - ISSN 0147-8389. - 39:3(2016), pp. 250-260. [10.1111/pace.12792]
Ziacchi, Matteo; Saporito, Davide; Zardini, Marco; Luzi, Mario; Quartieri, Fabio; Morgagni, Gianluigi; De Maria, Elia; Bertini, Matteo; Carinci, Valeria; Boriani, Giuseppe; Biffi, Mauro
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1139576
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