Author + information
- Received October 27, 2017
- Revision received January 31, 2018
- Accepted February 2, 2018
- Published online July 16, 2018.
- Wouter M. van Everdingen, MD, PhDa,∗ (, )
- Alwin Zweerink, MDb,
- Odette A.E. Salden, MDa,
- Maarten J. Cramer, MD, PhDa,
- Pieter A. Doevendans, MD, PhDa,
- Elien B. Engels, PhDc,
- Albert C. van Rossum, MD, PhDb,
- Frits W. Prinzen, PhDc,
- Kevin Vernooy, MD, PhDd,
- Cornelis P. Allaart, MD, PhDb and
- Mathias Meine, MD, PhDa
- aDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- bDepartment of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
- cDepartment of Physiology, CARIM, Maastricht University, Maastricht, the Netherlands
- dDepartment of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- ↵∗Address for correspondence:
Dr. Wouter M. van Everdingen, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
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 (Δ%SW) compared with baseline measurements during intrinsic conduction. Δ%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Δ%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 (Δ%SW +15 ± 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Δ%SW with MPP compared with BIV-OPT (−5 ± 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Δ%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.
- acute hemodynamic response
- cardiac resynchronization therapy
- multipoint pacing
- pressure-volume loops
- quadripolar lead
This study was conducted with an unrestricted research grant from St. Jude Medical (St. Paul, Minnesota). Dr. Prinzen has received research grant support from Medtronic, Boston Scientific, St. Jude Medical, Abbott, LivaNova, Biosense Webster, Merck Sharp & Dohme, Biotronik, and EBR Systems; and has served as an advisor for Medtronic Inc. Dr. Vernooy has received speaker fees and research grants from St. Jude Medical. Dr. Meine has received research grant support from Boston Scientific and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 27, 2017.
- Revision received January 31, 2018.
- Accepted February 2, 2018.
- 2018 American College of Cardiology Foundation
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