Department of Medicine, University of Rochester Medical Center, Rochester, New York.
Cardiology Department, University of Michigan, Ann Arbor, Michigan.
Pacing Clin Electrophysiol. 2020 Apr;43(4):412-417. doi: 10.1111/pace.13889.
Limited studies are available on the clinical significance of left ventricular (LV) lead polarity in patients undergoing cardiac resynchronization therapy (CRT), with a recent study suggesting better outcomes with LV true bipolar pacing.
We aimed to determine whether true bipolar LV pacing is associated with reduced mortality in a large, real-life CRT cohort, followed by remote monitoring.
We analyzed de-identified device data from CRT patients followed by the Boston Scientific LATITUDE remote monitoring database system. Patients with LV bipolar leads paced between the LV ring and LV tip were identified as true bipolar and those with LV bipolar leads paced between LV tip or LV ring and right ventricular (RV) coil were identified as extended bipolar. Patients with unipolar leads were identified as unipolar.
Of the 59 046 patients included in the study, 2927 had unipolar pacing, 34 390 had extended bipolar pacing, and 21 729 had true bipolar pacing. LV true bipolar pacing was associated with a significant 30% lower risk of all-cause mortality as compared to unipolar pacing (hazards ratio [HR] = 0.70, 95% CI: 0.62-0.79, P < .001), after adjustment for age, gender, LV lead impedance, LV pacing threshold, and BIV pacing percentage <95%. Extended bipolar LV pacing was also associated with 24% lower risk of all-cause mortality when compared to unipolar LV pacing (HR = 0.76, 95% CI: 0.68-0.85; P < .001). However, there were no differences in outcomes between true bipolar and extended bipolar LV pacing (HR = 0.97, 95% CI: 0.93-1.01; P = .198).
True bipolar or extended bipolar LV pacing is associated with a lower risk of mortality in CRT patients as compared to unipolar LV pacing.
目前关于心脏再同步治疗（CRT）患者左心室（LV）导联极性的临床意义的研究有限，最近的一项研究表明，LV 真正双极起搏的效果更好。
我们旨在通过远程监测，确定在一个大型真实 CRT 队列中，真正的双极 LV 起搏是否与降低死亡率相关。
我们分析了接受 CRT 治疗的患者的设备数据，并通过波士顿科学 LATITUDE 远程监测数据库系统进行随访。LV 双极导联起搏在 LV 环和 LV 尖端之间的患者被确定为真正的双极起搏，而 LV 双极导联起搏在 LV 尖端或 LV 环和右心室（RV）线圈之间的患者被确定为扩展双极起搏。使用单极导联的患者被确定为单极起搏。
在这项研究中，共有 59046 名患者，其中 2927 名患者使用单极起搏，34390 名患者使用扩展双极起搏，21729 名患者使用真正的双极起搏。与单极起搏相比，LV 真正的双极起搏的全因死亡率风险显著降低 30%（风险比 [HR] = 0.70，95%置信区间：0.62-0.79，P < 0.001），调整年龄、性别、LV 导联阻抗、LV 起搏阈值和 BIV 起搏百分比<95%后。与单极 LV 起搏相比，扩展双极 LV 起搏也与全因死亡率降低 24%相关（HR = 0.76，95%置信区间：0.68-0.85；P < 0.001）。然而，真正的双极起搏和扩展双极起搏之间的结果没有差异（HR = 0.97，95%置信区间：0.93-1.01；P = 0.198）。
与单极 LV 起搏相比，CRT 患者中真正的双极或扩展双极 LV 起搏与死亡率降低相关。
