Hemodynamic comparison of different multisites and multipoint pacing strategies in cardiac resynchronization therapies

Francesco Zanon*, Lina Marcantoni, Enrico Baracca, Gianni Pastore, Giuseppina Giau, Gianluca Rigatelli, Daniela Lanza, Claudio Picariello, Silvio Aggio, Sara Giatti, Marco Zuin, Loris Roncon, Domenico Pacetta, Franco Noventa, Frits W. Prinzen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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PurposeIn order to increase the responder rate to CRT, stimulation of the left ventricular (LV) from multiple sites has been suggested as a promising alternative to standard biventricular pacing (BIV). The aim of the study was to compare, in a group of candidates for CRT, the effects of different pacing configurationsBIV, triple ventricular (TRIV) by means of two LV leads, multipoint (MPP), and multipoint plus a second LV lead (MPP + TRIV) pacingon both hemodynamics and QRS duration.MethodsFifteen patients (13 male) with permanent AF (mean age 767years; left ventricular ejection fraction 337%; 7 with ischemic cardiomyopathy; mean QRS duration 178 +/- 25ms) were selected as candidates for CRT. Two LV leads were positioned in two different branches of the coronary sinus. Acute hemodynamic response was evaluated by means of a RADI pressure wire as the variation in LVdp/dtmax.Resultsp id="Par3"Per patient, 2.7 +/- 0.7 veins and 5.2 +/- 1.9 pacing sites were evaluated. From baseline values of 998 +/- 186mmHg/s, BIV, TRIV, MPP, and MPP-TRIV pacing increased LVdp/dtmax to 1200 +/- 281mmHg/s, 1226 +/- 284mmHg/s, 1274 +/- 303mmHg, and 1289 +/- 298mmHg, respectively (p<0.001). Bonferroni post-hoc analysis showed significantly higher values during all pacing configurations in comparison with the baseline; moreover, higher values were recorded during MPP and MPP + TRIV than at the baseline or during BIV and also during MPP + TRIV than during TRIV. Mean QRS width decreased from 178 +/- 25ms at the baseline to 171 +/- 21, 167 +/- 20, 168 +/- 20, and 164 +/- 15ms, during BIV, TRIV, MPP, and MPP-TRIV, respectively (p<0.001).Conclusionsp id="Par4"In patients with AF, the acute response to CRT improves as the size of the early activated LV region increases.
Original languageEnglish
Pages (from-to)31-39
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Issue number1
Publication statusPublished - 1 Oct 2018


  • Heart failure
  • Multisite pacing
  • Multipoint pacing
  • Dual LV site pacing
  • Hemodynamic optimization
  • Electrical delay

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