Single-center experience of a quadripolar pacing lead for cardiac resynchronization therapy.

AIM: Recent studies have shown that a quadripolar left ventricular (LV) lead can result in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and on medium-term follow-up in cardiac resynchronization therapy (CRT). We evaluated the outcomes of CRT patients in whom a quadripolar LV lead was implanted in our institution. METHODS: We studied 45 consecutive heart failure patients (75 % men; age, 70.3 ± 9.0 years) following successful implantation of a quadripolar LV lead. Demographic and clinical data were collected preoperatively, and patients were followed up for 18.9 months. RESULTS: The implantation success rate was 100 %. Mean overall duration was 100.1 ± 34.6 min, and X-ray exposure time was 13.20 ± 13.5 min. The most distal effective pacing site was used as the final pacing configuration in all patients. Acute dislodgment requiring reoperation occurred before discharge in three cases (6.6 %). Six patients (13 %) suffered PNS during follow-up; we solved this problem by changing the stimulation vector. Three months after implantation, a mean of six out of ten effective sites (threshold <2.5 V at 1.5 ms, no PNS) per patient was recorded. CONCLUSIONS: Over the relatively long term, the quadripolar LV lead was associated with excellent pacing thresholds and low rates of dislocation and PNS.

Short- and long-term outcomes of percutaneous coronary interventions in patients with severe left ventricular dysfunction.

AIMS: Poor left ventricular function is considered a high risk condition for performing either percutaneous (PCI) or surgical revascularisation. The aim of this study was to evaluate immediate and long term results of PCI in patients with coronary artery disease (CAD) and severe left ventricular dysfunction (EF < 0.30). METHODS AND RESULTS: Seventy-eight consecutive patients with CAD and severe left ventricular dysfunction (EF < 30%) were selected. The majority of these patients (87%) had multivessel disease. Coronary angioplasty procedure was mainly motivated by angina associated with clinical manifestation of heart failure (54%). Total number of treated vessels was 181, and a total of 203 stents were implanted (2.6 stent/patient). Procedural success was achieved in 77 patients (97.8%). The total procedural and in-hospital adverse event rate was 7.8%. Mean follow-up period (FU) was 25+/-6 months. Event-free survival rate at the end of FU was 55%; repeat revascularisation was performed in 21 patients (27.6%). Female gender, diabetes, new acute myocardial infarction and number of treated vessels were independent predictors for death and combined mayor adverse cardiac events (MACE) during the follow-up. CONCLUSIONS: In symptomatic patients with CAD and severe left ventricular dysfunction, PCI can be performed with excellent procedural outcome and acceptable long-term morbidity and mortality.