A meta-analysis of cardiac resynchronization therapy with quadripolar versus bipolar left ventricular leads on outcomes

Wang Yibo; Peng Yu; Bai Ming; Yao Yali; Zhang Zheng

doi:10.3969/j.issn.1674-4055.2018.02.06

Abstract：Objective To compare the outcomes of cardiac resynchronization therapy with implanted left ventricular quadripolar leads and bipolar leads by meta-analyze published studies of randomized controlled trials and observational study. Methods Databases including PubMed, EMbase, Cochrane Central Register of Controlled Trials, Web Of Science, CNKI, WanFang and VIP were searched. The time frame for the search was established in June 2017, and the data were collected according to the inclusion criteria. Meta-analysis was performed using RevMan 5.3 software after completing the data collection and quality evaluation. Results A total of 10 studies involving 28 196 patients were included. The results of meta-analysis showed that, compared with traditional bipolar leads, implantation of left ventricular quadripolar leads significantly reduces post-operative lead replacement, dislodgement, deactivation, and surgical revision (OR=0.53, 95%CI: 0.44~0.63, P<0.00001). After pacemaker program, it can be better to eliminate phrenic nerve stimulation (OR=0.21, 95%CI: 0.09~0.50, P=0.0004). All-cause death was significantly reduced (OR=0.60, 95%CI: 0.54~0.67, P<0.00001). Hospitalization for heart failure was also significantly reduced (OR=0.34, 95%CI: 0.16~0.75, P=0.007). Conclusions Cardiac resynchronization therapy with implanted left ventricular quadripolar leads is superior to traditional bipolar leads in lead replacement, dislodgement, deactivation, and surgical revision, phrenic nerve stimulation, all-cause death and hospitalization for heart failure, and can be significantly improved cardiac resynchronization therapy response, efficacy and quality of life of the patient.