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.

中文翻译：

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真正的双极或延长双极左心室起搏与心脏再同步治疗患者的更好生存有关。

背景技术关于进行心脏再同步（CRT）的患者左心室铅极性的临床意义的研究有限，最近的一项研究表明，LV真正的双极起搏可以改善预后。目的我们旨在确定在真实的大型CRT队列中，True-Bipolar LV起搏是否与降低死亡率有关，然后进行远程监测。方法我们分析了来自CRT患者的去识别设备数据，然后分析了Boston Scientific LATITUDE远程监控数据库系统。LV双极导线位于LV环和LV尖端之间的患者被确定为True-Bipolar，而LV双极导线位于LV尖端或LV环与RV线圈之间的患者被确定为扩展双极。具有单极导线的患者被识别为单极。结果59 该研究中包括046例患者，其中2927例单极起搏，34390例双极起搏，21729例真双极起搏。调整了年龄，性别，左室压力后，与单极起搏器相比，全真双极起搏器的全因死亡率显着降低了30％（HR = 0.70，95％CI：0.62-0.79，p <0.001）导线阻抗，LV起搏阈值和BIV起搏百分比<95％。与单极LV起搏相比，双极LV长期起搏还使全因死亡率降低了24％（HR = 0.76，95％CI：0.68-0.85; p <0.001）。但是，真正的双极或延长双极左心室起搏的结果无差异（HR = 0.97，95％CI：0.93-1.01； p = 0.198）。结论与单极LV起搏相比，真双极和延长双极LV起搏与心脏再同步治疗患者的死亡风险较低。本文受版权保护。版权所有。