Mechanistic insights into the benefits of multisite pacing in cardiac resynchronization therapy: The importance of electrical substrate and rate of left ventricular activation

Manav Sohal*, Anoop Shetty, Steven Niederer, Angela Lee, Zhong Chen, Tom Jackson, Jonathan M. Behar, Simon Claridge, Julian Bostock, Eoin Hyde, Reza Razavi, Frits Prinzen, C. Aldo Rinaldi

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND Multisite pacing (MSP) of the left ventricle is proposed as an alternative to conventional single-site LV pacing in cardiac resynchronization therapy (CRT). Reports on the benefits of MSP have been conflicting. A paradigm whereby not all patients derive benefit from MSP is emerging. OBJECTIVE We sought to compare the hemodynamic and electrical effects of MSP with the aim of identifying a subgroup of patients more likely to derive benefit from MSP. METHODS Sixteen patients with implanted CRT systems incorporating a quadripolar LV pacing lead were studied. Invasive hemodynamic and electroanatomic assessment was performed during the following rhythms: baseline (non-CRT); biventricular (BIV) pacing delivered via the implanted CRT system (BIVimplanted); BIV pacing delivered via an alternative temporary LV lead (BIValternative); dual-vein MSP delivered via 2 LV leads; MultiPoint Pacing delivered via 2 vectors of the quadripolar LV lead. RESULTS Seven patients had an acute hemodynamic response (AHR) of
Original languageEnglish
Pages (from-to)2449-2457
JournalHeart Rhythm
Issue number12
Publication statusPublished - Dec 2015


  • Cardiac resynchronization therapy
  • Multisite pacing
  • Noncontact mapping
  • Left bundle branch block
  • Acute hemodynamic response

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