Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, D Frankfurt, Germany.
Europace. 2019 Oct 1;21(10):1543-1549. doi: 10.1093/europace/euz196.
Some retrospective and prospective studies in heart failure patients with indication for cardiac resynchronization therapy (CRT) suggest better clinical outcomes for quadripolar (QP) left ventricular (LV) leads over bipolar (BP) leads. Although, lead failure remains an important safety concern, when using these more complex, novel electrodes. To evaluate safety and efficacy outcomes for QP vs. BP LV leads in patients receiving CRT.
We performed a comprehensive literature search through 2018 in PubMed, Cochrane Library, and Google Scholar databases to identify studies comparing patients with QP and BP LV CRT leads. A total of 12 studies were selected for analysis comprising 31 403 patients (QP lead: 22 429 patients; BP lead: 8974 patients). Eight studies examined the effects of CRT on survival. In these studies, use of QP electrodes was associated with significantly better survival compared to patients with BP LV leads (OR 0.61, 95% CI 0.50-0.76; P < 0.01). Clinical improval measured in New York Heart Association functional class (OR 0.59, 95% CI 0.34-1.01; P = 0.05) and hospitalization rates (OR 0.67, 95% CI 0.55-0.83; P < 0.01) were also improved in patients receiving QP leads. Lead malfunctions defined as LV lead failure resulting in lead deactivation (OR 0.57, 95% CI 0.34-0.98; P = 0.04) or LV lead dislodgement requiring LV lead replacement/repositioning (OR 0.48; 95% CI 0.31-0.75; P < 0.01) were more often encountered among patients with BP leads compared to patients with QP leads.
Our meta-analysis suggests distinct benefits of QP over BP electrodes in patients undergoing CRT.
一些针对心力衰竭患者心脏再同步治疗（CRT）适应证的回顾性和前瞻性研究表明，四极（QP）左心室（LV）导联比双极（BP）导联具有更好的临床结局。尽管使用这些更复杂、新颖的电极时，导联故障仍然是一个重要的安全问题。评估 QP 与 BP LV 导联在接受 CRT 的患者中的安全性和疗效。
我们通过 2018 年在 PubMed、Cochrane 图书馆和 Google Scholar 数据库中的全面文献检索，确定了比较 QP 和 BP LV CRT 导联患者的研究。共选择了 12 项研究进行分析，共纳入 31403 例患者（QP 导联：22429 例；BP 导联：8974 例）。八项研究检查了 CRT 对生存率的影响。在这些研究中，与使用 BP LV 导联的患者相比，使用 QP 电极与生存率显著提高相关（OR 0.61，95%CI 0.50-0.76；P<0.01）。纽约心脏协会功能分级（OR 0.59，95%CI 0.34-1.01；P=0.05）和住院率（OR 0.67，95%CI 0.55-0.83；P<0.01）的临床改善也在接受 QP 导联的患者中得到改善。LV 导联故障定义为 LV 导联失效导致导联失活（OR 0.57，95%CI 0.34-0.98；P=0.04）或 LV 导联脱位需要更换/重新定位 LV 导联（OR 0.48；95%CI 0.31-0.75；P<0.01）在接受 BP 导联的患者中比接受 QP 导联的患者更常见。
我们的荟萃分析表明，QP 电极在接受 CRT 的患者中具有明显优于 BP 电极的优势。
