QUADRIPOLAR ADVANTAGES FOR CARDIAC RESYNCHRONIZATION THERAPY
Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure, and it can help your patients avoid life-threatening changes in heart rhythm. CRT can also alleviate many of the symptoms experienced by your patients, improving their overall quality of life.
Quadripolar technology offers a significant advantage over bipolar technology—giving you the flexibility you need to access pacing sites and vectors outside of the reach of most devices, without compromising lead stability or performance.
QUARTET™ LV LEAD PROVIDES EXCELLENT OUTCOMES
When used in conjunction with our innovative suite of quadripolar technology-enabled CRT solutions, the Quartet™ lead supports improved patient outcomes.
- After 18 months, 97.4% of patients were successfully implanted with the quadripolar system; once placed, the LV lead remained stable with excellent pacing thresholds during follow-up (15 ± 5 months)1
- The Quartet lead was used to address phrenic nerve stimulation (PNS) noninvasively in 100% of cases2
- Use of quadripolar pacing technology resulted in:
- Lower risk of lead deactivation or replacement than bipolar leads, as well as lower capture thresholds in comparison to unipolar or bipolar leads3,4
- Significantly lower capture thresholds in comparison to unipolar or bipolar leads3
- Very low dislodgment rates3
- Among patients with high capture thresholds, the use of a quadripolar lead has extended battery life by up to 17 months4
REDUCES PATIENT AND HOSPITAL COSTS
Cost analysis performed on a single-center registry showed that the Quartet quadripolar LV lead was associated with significantly reduced hospitalizations, specific to heart failure (HF) and left ventricular (LV) lead surgical revision.5
Study Results
- In-patient heart failure hospitalization rates and LV lead surgical revisions were 54% lower for the quadripolar group (0.15/patient-year than for the bipolar LV group (0.32/patient-year) (p = 0.04).5
- The hospitalization rate reduction was accompanied with statistically significant cost savings of 62% (p = 0.016).5
BENEFITS OF QUADRIPOLAR TECHNOLOGY
The use of quadripolar technology offers you and your hospital or clinic many clinical, economic and operational advantages, over bipolar technology, including:
Reduced cost
- 39.8% reduction in Heart Failure hospitalization cost6
- 54% lower hospitalization rate5
- Overall cost savings (effective resource utilization)7
- 32.1% reduction of 30 day readmission rate6
- Reduction in phrenic nerves stimulation (PNS)8 and surgical lead revisions9
Improved outcomes
- 18% relative reduction in all-cause mortality10
- Increase in dP/dt with biventricular (BiV) pacing at site of late activation11
- Improved hemodynamics12
Operational efficiency, implant success and lead performance
In clinical studies, quadripolar pacing technology has resulted in:
- Significantly lower risk of lead deactivation or replacement than bipolar leads3
OUR QUADRIPOLAR CRT SYSTEM IS ASSOCIATED WITH INCREASED SURVIVAL
Patients with a quadripolar system may receive more effective CRT than those with bipolar LV pacing:4
Mortality results
Mortality incidence was significantly lower in the quadripolar group.10
- Quadripolar: 5.04 deaths per 100 patient-years
- Bipolar: 6.45 deaths per 100 patient-years (p = 0.001)
After multivariate adjustment, the quadripolar lead was associated with a lower risk of death HR: 0.77; 95% CI: 0.69 to 0.86; p < 0.001.10
MORTALITY CONCLUSIONS
CRT with quadripolar LV system was associated with an 18% relative reduction in mortality compared with a bipolar LV system.10
BUILDING COMPREHENSIVE HEART FAILURE MANAGEMENT
The Quartet™ quadripolar LV lead is part of our heart failure portfolio. Our vision is to transform the treatment of heart failures by designing technology that delivers excellent clinical outcomes and improves workflow and efficiency. Read more about the portfolio and our approach to heart failure management.
RESOURCES AND DOCUMENTATION
Product Manuals (Instructions for Use)
REFERENCES
1. Forleo, G. B., Mantica, M., Di Biase, L., Panattoni, G., Della Rocca, D. G., Papavasileiou, L. P., … Romeo, F. (2012). Clinical and procedural outcome of patients implanted with a quadripolar left ventricular lead: Early results of a prospective multicenter study. Heart Rhythm, 9(11), 1822-1828. http://dx.doi.org/10.1016/j.hrthm.2012.07.021
2. Tomassoni, G. Baker, J., Corbisiero, R., Love, C., Martin, D., Niazi, I., … Zhang, Z. (2013). Post-operative performance of the Quatet™ Left Ventriocular Heart Lead. J Cardiovasc Electrophysiol 24(4). 449-456. https://dx.doi.org/10.1111/jce.12065
3. Turakhia, M. P., Gold, M. R., Fischer, A., Sloman, L. S., Kumar, C., Dalal, N., … Cao, M., (2013). Decreased rate of left ventricular lead deactivation and replacement associated with use of quadripolar LV leads. Europace, 15(Suppl. 2), S47. http://dx.doi.org/10.1093/europace/eut169
4. Manyam, H., Bhimani, A. A., Sadrpour, S. A., De Oliveira, S. A., Goldstein, R., N., Cakulev, I., … Mackall, J. (2013). Quadripolar left ventricular leads yield lower capture thresholds with expected increase in battery longevity. Heart Rhythm, 10(5) S228. http://dx.doi.org/10.1016/j.hrthm.2013.03.019
5. Forleo, G. B., Di Biase, L., Bharmi, R., Dalal, N., Panattoni, G., Pollastrelli, A., … Romeo, G. (2015). Hospitalization rates and associated cost analysis of cardiac resynchronization therapy with an implantable defibrillator and quadripolar vs. bipolar left ventricular leads: a comparative effectiveness study. Europace, 17(1), 101-107. http://dx.doi.org/10.1093/europace/euu290
6.Corbisiero, R., Kazemian, P., Bharmi, R., Shar, R., Muller, D. (2016). Less with More: Hospitalization cost and Event Rates with Quadripolar versus Bipolar CRT-D. PACE 39(10). 1038-1045. https://dx.doi.org/10.1111/pace.12923
7. Graham, C. M., Gayle, J., & Magee, G. (2014, May). Comparison of healthcare utilization and hospital costs for quadripolar versus bipolar LV lead technologies. Presented at the meeting of the Heart Rhythm Society, San Francisco, CA.
8. Mehta, P. A., Shetty, A. K., Squirrel, M., Bostock, J., & Rinaldi, C. A. (2012). Elimination of phrenic nerve stimulation occurring during CRT: Follow-up in patients implanted with a novel quadripolar pacing lead. Journal of Interventional Cardiac Electrophysiology, 33(1), 43-49. http://dx.doi.org/ 10.1007/s10840-011-9598-5
9. Viani, S. M., Segreti, L., Di Cori, A., Zucchelli, G., Paperinin, L., Soldati, E., … Bongiorni, M. G. (2011). A new quadripolar lead for left ventricular pacing: Short term reliability and future opportunities. Europace, 13(Suppl. 3). http://dx.doi.org/10.1093/europace/eur220
10. Turakhia, M., Cao, M., Fischer, A., Nabutovsky, Y., Sloman, L. S., Dalal, Nirav., Gold, M. R. (2018). Reduced mortality associated with quadripolar compared to bipolar left ventricular leads in cardiac resynchronization therapy. J Am Coll Cardiol EP. 2(4). 426-33. https://dx.doi.org/10.1016/j.jacep.2016.02.007
11. Pappone, C., et al. (2012, October). Left ventricular pacing from a site of late electrical activation improves acute hemodynamic response to cardiac resynchronization therapy. Presented at the meeting of the Asia Pacific Heart Rhythm Society, Taipei, Taiwan.
12. Gutleben, K. J., Kranig, W., Barr, C., Morgenstern, M. M., Simon, M., & Dalal, Y. H. (2011). LV-pacing: Vector optimization using a novel quadripolar electrode acutely improves cardiac output in cardiac resynchronization therapy patients. Europace, 13(3), P403. http://dx.doi.org/10.1093/europace/eur220