Characterization of ventricular activation pattern and acute hemodynamics during multipoint left ventricular pacing

Menardi, Endrj; Ballari, Gian Paolo; Goletto, Cecilia; Rossetti, Guido; Vado, Antonello

doi:10.1016/j.hrthm.2015.04.029

Cited by 44 publications

(32 citation statements)

References 20 publications

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“…The best hemodynamic response is difficult to predict for an individual patient, though the distalproximal configuration is most likely to provide the best LV dP/dt max . 73,80,[85][86][87][88] The results suggest that multisite LV pacing results in an improvement in hemodynamics as compared with standard, single-site LV pacing, though this has not been confirmed in all studies. More details on the performance of quadripolar LV leads are included in Chapter 3, Cardiac Electrical Stimulation.…”

Section: Quadripolar Leads and Multisite Left Ventricular Pacingmentioning

confidence: 87%

“…[69][70][71] Using a quadripolar lead, almost any two of the four LV electrodes (1 = distal, 2, 3, or 4 = proximal) can be used as the cathode and anode, respectively, or any one of the LV electrodes can be programmed as the cathode with the RV ring electrode used as the anode. [73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] The hypothesis has been that multisite LV pacing may allow more complete synchronization of LV contraction and improve the clinical response to CRT. The best hemodynamic response is difficult to predict for an individual patient, though the distalproximal configuration is most likely to provide the best LV dP/dt max .…”

Section: Quadripolar Leads and Multisite Left Ventricular Pacingmentioning

confidence: 99%

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Coronary Sinus Lead Implantation

Worley¹

2017

Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy

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Section: Quadripolar Leads and Multisite Left Ventricular Pacingmentioning

confidence: 87%

Section: Quadripolar Leads and Multisite Left Ventricular Pacingmentioning

confidence: 99%

Coronary Sinus Lead Implantation

Worley¹

2017

Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy

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“…Pacing from multiple LV sites may improve the response of these patients by capturing a larger area of myocardial tissue, improving depolarization and repolarization patterns, and capturing areas adjacent to scar tissue. Studies of activation patterns reveal that MPP is able to recruit a greater portion of the LV, generating a flat wave-front with a higher conduction velocity [12]. Zanon et al showed that MPP induced contractility improvements, measured by dP/dt, in association with QRS narrowing, when compared with conventional biventricular pacing [11].…”

Section: Discussionmentioning

confidence: 99%

“…Preliminary studies have demonstrated an acute improvement in LV dP/dt Max [9] and hemodynamic parameters based on pressure-volume loops [10]. Furthermore, MPP has been shown to shorten the QRS duration in comparison with conventional biventricular pacing [11], shorten LV activation time [12], and improve both medium- and long-term outcomes [13, 14]. Pacing from multiple LV sites may improve the response to CRT by capturing a larger area of myocardial tissue, improving depolarization and repolarization patterns, and capturing areas adjacent to scar tissue [15].…”

Section: Introductionmentioning

confidence: 99%

Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial

Gasparini

Galimberti

Bragato

et al. 2016

Trials

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BackgroundDespite an intensive search for predictors of the response to cardiac resynchronization therapy (CRT), the QRS duration remains the simplest and most robust predictor of a positive response. QRS duration of ≥ 130 ms is considered to be a prerequisite for CRT; however, some studies have shown that CRT may also be effective in heart failure (HF) patients with a narrow QRS (<130 ms). Since CRT can now be performed by pacing the left ventricle from multiple vectors via a single quadripolar lead, it is possible that multipoint pacing (MPP) might be effective in HF patients with a narrow QRS. This article reports the design of the MPP Narrow QRS trial, a prospective, randomized, multicenter, controlled feasibility study to investigate the efficacy of MPP using two LV pacing vectors in patients with a narrow QRS complex (100–130 ms).MethodsFifty patients with a standard ICD indication will be enrolled and randomized (1:1) to either an MPP group or a Standard ICD group. All patients will undergo a low-dose dobutamine stress echo test and only those with contractile reserve will be included in the study and randomized. The primary endpoint will be the percentage of patients in each group that have reverse remodeling at 12 months, defined as a reduction in left ventricular end-systolic volume (LVESV) of >15% from the baseline.DiscussionThis feasibility study will determine whether MPP improves reverse remodeling, as compared with standard ICD, in HF patients who have a narrow QRS complex (100–130 ms).Trial registrationClinicalTrials.gov, NCT02402816. Registered on 25 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1698-1) contains supplementary material, which is available to authorized users.

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“…Multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], Abbott, Sylmar, CA, USA) was recently proposed to further enhance CRT in HF patients. Early clinical studies have shown that MPP, compared with conventional biventricular CRT (CONV), provides acute benefits to LV hemodynamic responses (dP/dt max ), dyssynchrony, and electrical activation . More recent data documented that MPP resulted in greater LV reverse remodeling and significant increase in LV EF with pressure‐volume (P‐V) loop‐guided programming over patients randomized to receive CONV with similar P‐V loop guidance at 1‐year follow‐up .…”

Section: Introductionmentioning

confidence: 99%

Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

Ciconte

Ćalović

Vicedomini

et al. 2018

Pacing Clinical Electrophis

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Background Multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], Abbott, Sylmar, CA, USA) improves the response rate to cardiac resynchronization therapy (CRT). We evaluated the feasibility of noninvasive radial artery tonometry (RAT) to characterize arterial pressure morphology changes (pre‐ejection period [PEP] and ejection duration [ED]) between conventional CRT and MPP pacing interventions. Methods Patients with a MPP‐enabled CRT device (Quadra Assura MP™, Abbott) underwent noninvasive RAT assessment (SphygmoCor CVMS, AtCor Medical Inc., Itasca, IL, USA) at 3–6 months after implantation. A pacing protocol was performed in a randomized order including one optimized conventional biventricular CRT (CONV) configuration using the distal electrode and five MPP configurations. The PEP, ED, and PEP/ED ratio were determined for each intervention from the RAT pressure waveform and electrocardiogram. Results Pressure waveforms were successfully recorded in 19 patients (89% male, QRS 147 ± 16 ms, 63% ischemic). In 17/19 (89%) patients, at least one MPP intervention resulted in improved PEP, ED, and PEP/ED compared to CONV. The MPP intervention with greatest separation of LV cathodes and minimum intra‐LV delay significantly improved PEP (mean PEP –15 ± 33% vs –8 ± 32% [CONV], P = 0.04) and ED (mean ED +8 ± 8% [MPP] vs +4 ± 7% [CONV], P = 0.02), and PEP/ED (–0.07 ± 0.14 [MPP] vs –0.04 ± 0.13 [CONV], P = 0.02) compared with CONV. Conclusions Noninvasive RAT efficiently characterizes changes in PEP and ED between CONV and MPP interventions. MPP configurations using the widest separation among LV cathodes and minimum intra‐LV delay may significantly improve RAT‐derived parameters as compared to conventional CRT.

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Characterization of ventricular activation pattern and acute hemodynamics during multipoint left ventricular pacing

Cited by 44 publications

References 20 publications

Coronary Sinus Lead Implantation

Coronary Sinus Lead Implantation

Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial

Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

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