Pacing electrode selection in a quadripolar left heart lead determines presence or absence of phrenic nerve stimulation.

A 60-year-old ischaemic patient presented for routine cardiac resynchronization therapy (CRT)-D implantation. An investigational quadripolar left ventricular lead was placed in the posterolateral vein. Phrenic nerve stimulation (PNS) was observed, but it occurred during pacing from only one of the four electrodes. A lead with multiple pacing electrodes is a potential alternative to physical adjustment of the lead or discontinuing CRT when PNS occurs.