Author + information
Background: The introduction of quadripolar (QP) cardiac resynchronization therapy (CRT) leads aimed to improve procedural success rates. The National Cardiovascular Data Registry (NCDR) was analyzed to characterize the use and procedural outcomes of these novel leads in comparison with traditional bipolar (BP) leads.
Methods: We analyzed data on 175,684 CRT device placement procedures between September 1st 2010 and December 31st 2015 reported in the NCDR. Patients with prior CRT devices, prior coronary sinus leads, epicardial leads, and those who received multiple procedures during the same admission were excluded from analysis. Baseline patient characteristics, types of leads implanted, and rates of placement failure and complications were analyzed.
Results: The successful CRT lead placement cohort included 160,022 procedures. Since its approval in November 2011, successful QP lead placement has exponentially risen from 7,452 leads (24.8% of total CRT leads placed in 2012) to 28,926 leads (84% of total CRT leads placed in 2015). Among all CRT device implants, there has been a statistically significant drop in reported lead placement failure from 6.04% (95% CI 5.14 % – 6.93%) in the last quarter of 2010 to 5.21% (95% CI 4.75% – 5.68%) in the last quarter of 2015 (trend p value < 0.0001). Although reported diaphragmatic stimulation rates resulting in failure of lead placement were low, there has been a statistically significant drop in the reported rates from 0.07% (95% CI 0% – 0.18%) in the last quarter of 2010 to 0.01% (95% CI 0% – 0.03%) in the last quarter of 2015 (trend p value < 0.007). There was no statistically significant change in trend of unacceptable thresholds as reason for lead placement failure between the last quarters of 2010 and 2015, 0.29% (95% CI 0.09% – 0.50%) and 0.17% (95% CI 0.09% – 0.26%) respectively with trend p value 0.106. There was no statistically significant difference in procedural complication rates between QP and BP leads, 1.34% and 1.39% (p value 0.50) respectively.
Conclusions: Subsequent to the introduction of QP leads, there has been a rapid adoption of these novel leads and a statistically significant reduction of CRT lead placement failure and diaphragmatic stimulation rates.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 10:15 a.m.-10:25 a.m.
Session Title: Arrhythmias and Heart Failure
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1305M-07
- 2017 American College of Cardiology Foundation