VIDEO: NAVIGATE-X4 trial shows promise of quadripolar lead technology

CHICAGO — At the American College of Cardiology Scientific Session, Suneet Mittal, MD, director of electrophysiology at the Valley Hospital Health System of Ridgewood, New Jersey and New York, discusses the results of the NAVIGATE-X4 trial of a cardiac resynchronization therapy device with a quadripolar lead (Acuity X4, Boston Scientific).

Although quadripolar leads are not a new concept, they have traditionally not been able to pace from the basal regions of the heart, because quadripolar leads do not allow for pacing in low pacing thresholds from the apex of the heart to the basal regions, he said.

“This is very disadvantageous to patients because if you pace from basal locations, thresholds are high and that consumes battery very quickly, which then requires patients to undergo repeated operations to replace the generator, which then exposes them to risk of infection,” said Mittal.

The 800-patient, multicenter NAVIGATE-X4 trial tested a novel set of quadripolar leads designed to overcome basal-location challenges.

“Not only could leads be implanted successfully in nearly all patients [and not be] associated with lead dislodgement, phrenic nerve stimulation was rare and could easily be treated with electronic repositioning,” Mittal said. “Most important, pacing from the base of the heart was associated with lower thresholds that were even seen from the tip of the heart, and this was the first time this has ever been shown with quadripolar lead technology.”