Introduction: High thresholds, phrenic nerve stimulation can reduce the success of CRT options. A new generation quadripolar lead (Quad-LV - Attain Performa) with shorter spacing between the two center electrodes and 16 different pacing vectors has been introduced to overcome LV lead troubles.
Methods: Eight patients were implanted with CRT-d. Median procedural time 90min, fluoroscopy 13min. In one patient the CS was not cannulated. One patient needed to switch to a bipolar LV lead. Only two patients another branch than the 1st target was cannulated (tortuosity or small size of the vessel). A vector different from the standard bipolar one was chosen in 4 patients. In one case, the lead was repositioned twice (phrenic nerve stimulation and pacing captures). In all the Quad-LV was sufficiently stable when removing the delivery. Phrenic nerve stimulation (3 cases) was eliminated by changing the vector. All patients retained the choosen vector, while in one patient was modified at 1st follow-up.
Conclusions: Quad-LV provides excellent handling with good procedural and fluoroscopy times, the option for vector changes further increase the CRT technical success.