Abstract 19469: Quadripolar Left Ventricular Leads are Less likely to Dislodge or Require Repositioning

Abstract

Objective: Since quadripolar left ventricular (LV) leads allow pacing from multiple electrodes, they are less likely than other leads to be placed in unstable positions in order to optimize electrical pacing parameters. We therefore investigated the rate of lead revision and dislodgement in quadripolar (QUAD) vs. bipolar (BI) LV lead recipients. Methods: We retrospectively collected data for N=545 patients at our institution implanted with QUAD (n=173) vs. BI (n=372) LV leads from 2012-2014 and followed them to the endpoint of LV lead revision or lead dislodgement in the first 6 months after implantation. Time to event was analyzed by lead type using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models. Results: The cohort was aged 69.6 ± 11.5 years, 89.3% white, with mean BMI 29.8 ± 6.3 kg/m2. Patients were mostly NYHA Class III heart failure (55.7%), while 47.4% had diabetes, 78.9% had hypertension, and 50.8% had atrial fibrillation. Baseline characteristics were comparable in patients that received QUAD and BI leads. Patients receiving BI leads were more likely to require lead revisions during the index hospitalization (BI: 4.8% vs. QUAD: 1.1%, P=0.03). In the first 6 months of follow-up, patients getting QUAD leads had a significantly lower rate of LV lead dislodgement (7.0% vs. 1.7%, P<0.01, see Figure). In a multivariate model adjusted for age, diabetes, prior history of MI, atrial fibrillation, and NYHA class, the difference persisted (HR=0.26, 95% CI [0.08, 0.85], P=0.02). Conclusions: Quadripolar LV leads are less likely to dislodge or require lead revision during the index hospitalization or follow-up. These results have important clinical implications