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MORE CRT - Quadripolar lead trumps bipolar option in cardiac resynchronisation

Hot Line I: Cardiovascular disease: novel therapies

Arrhythmias and Device Therapy

BARCELONA, Spain – Saturday 30 August: Use of a quadripolar left ventricular (LV) lead instead of a bipolar option during cardiac resynchronisation therapy (CRT) can decrease complications at six months according to preliminary Hot Line results presented today 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, MD, PhD, from the University of Bologna, Italy.

CRT is a treatment for heart failure and involves placement of a pacemaker or implantable cardioverter-defibrillator (ICD) to ensure that the left and right ventricles of the heart effectively pump together.

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, randomised trial,” he added.

The MORE-CRT study included 1 068 heart failure patients scheduled for CRT from 63 centres in 13 countries.
Patients (aged approximately 68 years) were randomised 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”.

Notes to editor

SOURCES OF FUNDING: The study was funded by St. Jude Medical.
DISCLOSURES: Professor Boriani reported speaker fees from St. Jude, Medtronic, Boston and Boehringer for lectures at international conferences.
About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2014
The ESC Congress is currently the world's largest international congress in cardiovascular medicine.  The spotlight of this year's event is “innovation and the heart”.  ESC Congress 2014 takes place from 30 August to 3 September at the Fira Gran Via in Barcelona, Spain. For more information on ESC Congress 2014 contact the ESC Press Office.
To access all the scientific resources from the sessions during the congress, visit ESC Congress 365
This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2014. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.