TY - JOUR
T1 - In Heart Failure Patients with Left Bundle Branch Block Single Lead MultiSpot Left Ventricular Pacing Does Not Improve Acute Hemodynamic Response To Conventional Biventricular Pacing. A Multicenter Prospective, Interventional, Non-Randomized Study
AU - Sterlinski, Maciej
AU - Sokal, Adam
AU - Lenarczyk, Radoslaw
AU - Van Heuverswyn, Frederic
AU - Rinaldi, C. Aldo
AU - Vanderheyden, Marc
AU - Khalameizer, Vladimir
AU - Francis, Darrel
AU - Heynens, Joeri
AU - Stegemann, Berthold
AU - Cornelussen, Richard
PY - 2016/4/28
Y1 - 2016/4/28
N2 - Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive.The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV).Patients with left bundle branch block (LBBB) underwent an acute hemodynamic study to determine the %change in LV+dP/dtmax from baseline atrial pacing compared to the following configurations: BiV pacing with the LV lead in a one of lateral veins, while pacing from the distal, mid, or proximal electrode and all 3 electrodes together (i.e. MSP). All measurements were repeated 4 times at 5 different atrioventricular delays. We also measured QRS-width and individual Q-LV durations.Protocol was completed in 24 patients, all with LBBB (QRS width 171?20 ms) and 58% ischemic aetiology. The percentage change in LV+dP/dtmax for MSP pacing was 31.0?3.3% (Mean?SE), which was not significantly superior to any BiV pacing configuration: 28.9?3.2% (LV-distal), 28.3?2.7% (LV-mid), and 29.5?3.0% (LV-prox), respectively. Correlation between LV+dP/dtmax and either QRS-width or Q-LV ratio was poor.In patients with LBBB MultiSPOT LV pacing demonstrated comparable improvement in contractility to best conventional BiV pacing. Optimization of atrioventricular delay is important for the best performance for both BiV and MultiSPOT pacing configurations.ClinicalTrials.gov NTC01883141.
AB - Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive.The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV).Patients with left bundle branch block (LBBB) underwent an acute hemodynamic study to determine the %change in LV+dP/dtmax from baseline atrial pacing compared to the following configurations: BiV pacing with the LV lead in a one of lateral veins, while pacing from the distal, mid, or proximal electrode and all 3 electrodes together (i.e. MSP). All measurements were repeated 4 times at 5 different atrioventricular delays. We also measured QRS-width and individual Q-LV durations.Protocol was completed in 24 patients, all with LBBB (QRS width 171?20 ms) and 58% ischemic aetiology. The percentage change in LV+dP/dtmax for MSP pacing was 31.0?3.3% (Mean?SE), which was not significantly superior to any BiV pacing configuration: 28.9?3.2% (LV-distal), 28.3?2.7% (LV-mid), and 29.5?3.0% (LV-prox), respectively. Correlation between LV+dP/dtmax and either QRS-width or Q-LV ratio was poor.In patients with LBBB MultiSPOT LV pacing demonstrated comparable improvement in contractility to best conventional BiV pacing. Optimization of atrioventricular delay is important for the best performance for both BiV and MultiSPOT pacing configurations.ClinicalTrials.gov NTC01883141.
U2 - 10.1371/journal.pone.0154024
DO - 10.1371/journal.pone.0154024
M3 - Article
C2 - 27124724
SN - 1932-6203
VL - 11
JO - PLOS ONE
JF - PLOS ONE
IS - 4
M1 - e0154024
ER -