TY - JOUR
T1 - Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy
AU - van Everdingen, W.M.
AU - Zweerink, A.
AU - Salden, O.A.E.
AU - Cramer, M.J.
AU - Doevendans, P.A.
AU - Engels, E.B.
AU - van Rossum, A.C.
AU - Prinzen, F.W.
AU - Vernooy, K.
AU - Allaart, C.P.
AU - Meine, M.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - OBJECTIVES This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP.BACKGROUND MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy.METHODS Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Delta%SW) compared with baseline measurements during intrinsic conduction. Delta%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Delta%SW (BIV-OPT).RESULTS Forty-three patients were analyzed (age 66 +/- 10 years, 63% men, 30% ischemic cardiomyopathy, LV ejection fraction 29 +/- 8%, and QRS duration 175 +/- 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 +/- 8%, and variation between LV electrodes was 9 +/- 5%. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Delta%SW +15 +/- 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Delta%SW with MPP compared with BIV-OPT (-5 +/- 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Delta%SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis.CONCLUSIONS Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP. (c) 2018 by the American College of Cardiology Foundation.
AB - OBJECTIVES This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP.BACKGROUND MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy.METHODS Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Delta%SW) compared with baseline measurements during intrinsic conduction. Delta%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Delta%SW (BIV-OPT).RESULTS Forty-three patients were analyzed (age 66 +/- 10 years, 63% men, 30% ischemic cardiomyopathy, LV ejection fraction 29 +/- 8%, and QRS duration 175 +/- 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 +/- 8%, and variation between LV electrodes was 9 +/- 5%. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Delta%SW +15 +/- 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Delta%SW with MPP compared with BIV-OPT (-5 +/- 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Delta%SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis.CONCLUSIONS Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP. (c) 2018 by the American College of Cardiology Foundation.
KW - acute hemodynamic response
KW - cardiac resynchronization therapy
KW - multipoint pacing
KW - pressure-volume loops
KW - quadripolar lead
U2 - 10.1016/j.jacep.2018.02.005
DO - 10.1016/j.jacep.2018.02.005
M3 - Article
SN - 2405-500X
VL - 4
SP - 881
EP - 889
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 7
ER -