Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois.
Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois.
Heart Rhythm. 2020 Jan;17(1):81-89. doi: 10.1016/j.hrthm.2019.07.028. Epub 2019 Jul 29.
The introduction of quadripolar (QP) cardiac resynchronization therapy (CRT) leads aimed to improve procedural and clinical outcomes.
The National Cardiovascular Data Registry was analyzed to characterize the use as well as the procedural and clinical outcomes of QP leads in comparison with unipolar and bipolar (BP) leads.
We evaluated data on 175,684 procedures reported between September 1, 2010, and December 31, 2015. Clinical outcomes were analyzed using Centers for Medicare & Medicaid Services claims data.
Among all CRT device implants, there was a drop in reported lead placement failure from 6.04% to 5.21% (P < .0001 for trend) and a drop in the reported diaphragmatic stimulation rates from 0.07% to 0.01% (P < .007 for trend) between the last quarters of 2010 and 2015. No significant difference in procedural complication rates between QP and BP leads occurred (1.34% and 1.39%, respectively; P = .50). Among patients linked to Centers for Medicare & Medicaid Services claims data, no statistically significant difference in the combined primary outcome of death, congestive heart failure admission, device malfunction, and reoperation between BP and QP leads was observed (34.15 and 34.19 events per 100 patient-years, respectively; P = .89).
Since the introduction of QP leads, there was a reduction in CRT lead placement failure rates and a reduction in diaphragmatic stimulation rates. However, no statistically significant difference in long-term clinical outcomes between BP and QP leads was observed in elderly patients undergoing CRT implantation.
四极（QP）心脏再同步治疗（CRT）导线的引入旨在改善手术过程和临床结果。
分析国家心血管数据注册中心的数据，以描述 QP 导线的使用情况以及与单极和双极（BP）导线相比的手术过程和临床结果。
我们评估了 2010 年 9 月 1 日至 2015 年 12 月 31 日期间报告的 175684 例手术的数据。使用医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）的索赔数据分析临床结果。
在所有 CRT 设备植入物中，报告的导线放置失败率从 6.04%降至 5.21%（趋势 P <.0001），报告的膈肌刺激率从 0.07%降至 0.01%（趋势 P <.007）。2010 年最后几个季度和 2015 年之间。QP 和 BP 导联之间的手术并发症发生率无显著差异（分别为 1.34%和 1.39%；P =.50）。在与医疗保险和医疗补助服务中心索赔数据相关联的患者中，BP 和 QP 导联之间的主要复合终点（死亡、充血性心力衰竭入院、设备故障和再手术）无统计学显著差异（分别为每 100 例患者年 34.15 和 34.19 例事件；P =.89）。
自 QP 导联引入以来，CRT 导联放置失败率降低，膈肌刺激率降低。然而，在接受 CRT 植入的老年患者中，BP 和 QP 导联之间的长期临床结果无统计学显著差异。
