True bipolar or extended bipolar left ventricular pacing is associated with better survival in cardiac resynchronization therapy patients. Pacing and clinical electrophysiology : PACE Kutyifa, V., Jame, S., Wang, P. J., Musat, D., Jones, P., Wehrenberg, S., Stein, K. 2020


BACKGROUND: Limited studies are available on the clinical significance of left ventricular lead polarity in patients undergoing cardiac resynchronization (CRT), with a recent study suggesting better outcomes with LV true bipolar pacing.OBJECTIVES: 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.METHODS: 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 to RV coil were identified as Extended Bipolar. Patients with unipolar leads were identified as Unipolar.RESULTS: Of the 59,046 patients included in the study, 2,927 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 (HR = 0.70, 95% CI: 0.62-0.79, p<0.001), 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<0.001). However, there were no differences in outcomes between True-Bipolar or Extended-Bipolar LV pacing (HR = 0.97, 95% CI: 0.93-1.01; p = 0.198).CONCLUSION: True-Bipolar and Extended-Bipolar LV pacing is associated with a lower risk of mortality in cardiac resynchronization therapy patients as compared to Unipolar LV pacing. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/pace.13889

View details for PubMedID 32067233