Cabrera Bueno Fernando, Alzueta Rodríguez Javier, Olagüe de Ros José, Fernández-Lozano Ignacio, García Guerrero Juan José, de la Concha Joaquín Fernández, Hernández Madrid Antonio, Tolosana Viu Jose María, Osca Asensi Joaquín, Barrera Cordero Alberto, Llorente Hernangómez Elena
Hospital Universitario Virgen de Victoria, Málaga, Spain.
Pacing Clin Electrophysiol. 2013 Aug;36(8):963-9. doi: 10.1111/pace.12172. Epub 2013 May 21.
The Quartet quadripolar lead (St. Jude Medical Inc., St. Paul, MN, USA) offers 10 different left ventricle pacing configurations that may further influence hemodynamic parameters compared to traditional bipolar pacing configurations. The purpose of this study was to evaluate whether pacing from additional quadripolar lead vectors could enhance cardiac output (CO).
For each patient, CO was measured in "no-pacing" and in all the 10 configurations available, within 7 days of implantation of the device. Tip-ring, tip-right ventricular coil (RVC), and ring-RVC vectors were considered as traditional vectors. The seven additional configurations available in the quadripolar lead were considered as nontraditional vectors. CO was measured by ECHO. The best configuration was defined as the one presenting the highest CO measurement within configurations, which have a capture threshold <3 V and a safety margin between the capture and the phrenic nerve stimulation thresholds.
Fifty-one standard cardiac resynchronization therapy patients were enrolled. The mean of each patient's best CO obtained with traditional vectors was higher than the baseline nonpaced CO (4.16 L/min vs 3.64 L/min). The mean of each patient's best CO, including all 10 available configurations, was also higher than the baseline nonpaced CO (4.33 L/min vs 3.64 L/min). In addition, the mean of each patient's best CO obtained with the best configuration available through a quadripolar lead was better than the mean of each patient's best CO obtained with a traditional configuration. In 53% of patients, the best CO was obtained with a nontraditional vector unique to the quadripolar lead.
A quadripolar lead offers multiple additional pacing options to increase CO acutely compared to conventional bipolar leads.
四方四极导线（美国明尼苏达州圣保罗市圣犹达医疗公司）提供10种不同的左心室起搏配置，与传统双极起搏配置相比，可能会进一步影响血流动力学参数。本研究的目的是评估来自额外四极导线向量的起搏是否能提高心输出量（CO）。
对于每位患者，在植入设备后7天内，在“无起搏”状态及所有10种可用配置下测量CO。头端-环、头端-右心室线圈（RVC）和环-RVC向量被视为传统向量。四极导线中可用的另外七种配置被视为非传统向量。通过超声心动图测量CO。最佳配置被定义为在捕获阈值<3V且捕获与膈神经刺激阈值之间有安全裕度的配置中，呈现最高CO测量值的配置。
纳入了51例标准心脏再同步治疗患者。使用传统向量获得的每位患者最佳CO的平均值高于基线无起搏时的CO（4.16L/分钟对3.64L/分钟）。包括所有10种可用配置在内的每位患者最佳CO的平均值也高于基线无起搏时的CO（4.33L/分钟对3.64L/分钟）。此外，通过四极导线获得的最佳配置下每位患者最佳CO的平均值优于使用传统配置获得的每位患者最佳CO的平均值。在53%的患者中，最佳CO是通过四极导线特有的非传统向量获得的。
与传统双极导线相比，四极导线提供了多种额外的起搏选择，可急性增加CO。
