crt with a short spaced left ventricular quadripolar lead

CRT WITH A SHORT SPACED LEFT VENTRICULAR
QUADRIPOLAR LEAD (MEDTRONIC PERFORMA):
CLINICAL RESULTS AT MID-TERM.
Biffi M (1), Ziacchi M (1), Saporito D (2), Zardini M (3), Quartieri F(4), Morgagni
GL (5), Casali E (6), Bertini M (7), Luzi M (8), Carinci V (9), Boriani G (1); Per4mer
Investigators (1)Institute of Cardiology, S.Orsola-Malpighi Hospital, Bologna, Italy
(2)Division of Cardiology, Infermi Hospital, Rimini, Italy (3)Division of Cardiology,
Azienda Ospedaliero-Universitarie, Parma, Italy (4)Division of Cardiology,
Arcispedale S.Maria Nuova, Reggio Emilia, Italy (5)Division of Cardiology,
Macerata Hospital, Macerata, Italy (6)Institute of Cardiology, Azienda
Ospedaliera-Universitaria Modena Policlinico, Modena, Italy (7)Institute of
Cardiology, S.Anna Hospital, Ferrara, Italy (8)Cardiovascular Department, Riuniti
Hospital, Ancona, Italy (9)Cardiac Unit, Maggiore Hospital, Bologna, Italy
Purpose The rate of non-responder and the occurrence of phrenic nerve stimulation
(PNS) or of a high myocardial threshold (MT) are serious challenges in cardiac
resynchronization therapy CRT).
Methods 40 CRT patients (pts) were implanted with a left ventricular (LV)
Medtronic- Performa lead (PL) that uniquely features a 1.3 mm spaced dipole for
PNS avoidance, and were re-evaluated at 6 months (6M-Fup) by NYHA assessment,
Echocardiography, occurrence of either PNS or MT in every pacing configuration.
Results. At 6M-Fup 28(69%) pts were echocardiographic responders (> 15% end
systolic volume reduction). 31(77%) pts reduced NYHA class at least 1 point and
3(8%) pts died. No pts were transplanted. At implantation PNS occurred in at least
1/16 configurations in 16(41%) pts, and in 17(43%) at 6M-Fup. In both settings, all
the pts had at least 4 pacing configurations to manage PNS, and more than 5 pacing
configuration with the MT below [email protected] ms. At 6M-Fup 4(10%) pts had LV
lead dislodgement, but in a half reprogramming could restore LV capture. In the
other 2(5%) pts repeated surgery was necessary. Overall, 11(28%) pts changed LV
pacing configuration at 6M-Fup either because of PNS, increased MT or absence of
reverse remodeling.
Conclusions: 69% of pts with PL had LV reverse remodeling and only 5% of pts
had a LV lead dislodgment resulting in reoperation. The flexibility allowed by the PL
enables an easy management of PNS and high MT both at implant and at 6M-Fup.

Download Report