Multipoint pacing by a left ventricular quadripolar lead improves the acute hemodynamic response to CRT compared with conventional biventricular pacing at any site

Francesco Zanon*, Enrico Baracca, Gianni Pastore, Lina Marcantoni, Chiara Fraccaro, Daniela Lanza, Claudio Picariello, Silvio Aggio, Loris Roncon, Fabio Dell'Avvocata, GianLuca Rigatelli, Domenico Pacetta, Franco Noventa, Frits W. Prinzen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND Response to cardiac resynchronization therapy (CRT) remains challenging. Pacing from multiple sites of the left ventricle (LV) has shown promising results. OBJECTIVE The purpose of this study was to systematically compare the acute hemodynamic effects of multipoint pacing (MPP) by means of a quadripolar lead with conventional biventricular (BiV) pacing. METHODS Twenty-nine patients (23 men; mean age 72 12 years; LV ejection fraction 29% +/- 7%; 15 with ischemic cardiomyopathy, 17 with left bundle branch block; mean ORS 183 +/- 23 ms) underwent CRT implantation. Per patient, 3.2 +/- 1.2 different veins and 6.3 +/- 2.4 pacing sites were tested. LV electrical delay (Q-LV) was measured at each Location, along with the increase in LV dP/dt(max) (maximum rate of rise of LV pressure) obtained by BiV and MPP. The effect of MPP, by means of simultaneous pacing from distal and proximal dipoles, was investigated at all available sites. RESULTS Overall, 3.2 +/- 1.2 different MPP measurements were collected per patient. When all sites were considered, LV dP/d(max) increased from 951 +/- 193 mm Hg/s at baseline to 1144 +/- 255 and 1178 +/- 259 mm Hg/s on BiV and MPP, respectively. When the best site was considered, LV dP/dt(max) increased from a baseline value of 942 +/- 202 mm Hg/s to 1200 +/- 267 mm Hg/s (BiV) and 1231 +/- 267 mm Hg/s (MPP). The mean QRS duration at any site during MPP and conventional CRT was 171 +/- 18 and 175 +/- 16 ms (P = .003), respectively. CONCLUSION Compared with BiV pacing at any LV site, MPP yielded a small but consistent increase in hemodynamic response. A correlation between the increase in hemodynamics and Q-LV on MPP was observed for all measurements, including those taken at the best and worst sites. The MPP-induced improvement in contractility was associated with significantly greater narrowing of the QRS complex than conventional BiV pacing.
Original languageEnglish
Pages (from-to)975-981
JournalHeart Rhythm
Issue number5
Publication statusPublished - May 2015


  • Cardiac resynchronization therapy
  • Multipoint pacing
  • Hemodynamics

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