Use of a quadripolar left ventricular (LV) lead instead of a bipolar option during cardiac resynchronization therapy (CRT) can decrease complications at six months according to preliminary Hot Line results presented at ESC Congress 2014.

The MORE-CRT (More Options available with a quadripolar LV lead pRovidE in-clinic solutions to CRT challenges) trial "demonstrates the safety and efficiency of the quadripolar lead technology in providing more options to manage CRT patients," noted the study's lead investigator Giuseppe Boriani, M.D., Ph.D., from the University of Bologna, Italy.

The CRT device is implanted under the skin with "leads" or wires going into the heart. "However, in up to 10% of heart failure patients LV lead placement is not successful because of anatomical challenges, phrenic nerve stimulation or poor electrical measurements," explained Professor Boriani.

"Quadripolar pacing was developed with the aim of overcoming some of these barriers, but until now it has never been tested in a large, prospective, randomized trial," he added.

The MORE-CRT study included 1 068 heart failure patients scheduled for CRT from 63 centers in 13 countries. Patients (aged approximately 68 years) were randomized in a 1:2 ratio to undergo CRT with either a bipolar lead (controls; n=348) or a quadripolar lead (n=720).

The study showed that at six months, compared to controls, patients with quadripolar leads were significantly more likely to be free from a composite endpoint of both intra- and post-operative LV lead-related complications (85.97% vs. 76.86%, P=0.0001) – a relative risk reduction (RRR) of 40.8%.

The driver of this benefit was mainly intra-operative complications which were reduced by more than 50% in the quadripolar group, noted Professor Boriani (5.98% vs. 13.73%, P<0.0001, RRR 56.4%).

There were also fewer post-operative complications in the quadripolar group, but the difference was not statistically significant.

In conclusion, Professor Boriani said the quadripolar lead "provides more options to effectively manage common pacing complications, as compared to systems based on bipolar leads; hence, improving the efficiency of CRT".

The study was funded by St. Jude Medical.

Professor Boriani reported speaker fees from St. Jude, Medtronic, Boston and Boehringer for lectures at international conferences.