Multipoint Left Ventricular Pacing in a Single Coronary Sinus Branch Improves Mid‐Term Echocardiographic and Clinical Response to Cardiac Resynchronization Therapy

Pappone, Carlo; Ćalović, Žarko; Vicedomini, Gabriele; Cuko, Amarild; McSpadden, Luke C.; Ryu, Kyungmoo; Romano, Enrico; Baldi, Mario; Saviano, Massimo; Pappone, Alessia; Ciaccio, Cristiano; Giannelli, Luigi; Ionescu, Bogdan; Petretta, Andrea; Vitale, Raffaele; Fundaliotis, Angelica; Tavazzi, Luigi; Santinelli, Vincenzo

doi:10.1111/jce.12513

Cited by 52 publications

(37 citation statements)

References 32 publications

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“…Moreover, pacing with 5 ms LV1-LV2 delay produced the best dP/dt response more often than pacing with 40 ms LV1-LV2. 27 Recently, Pappone published 12-month follow-up data from this study. 28,38 The trend observed at 3 months was sustained; LVESV and EF were significantly improved in the MultiPoint pacing group relative to the CONV group.…”

mentioning

confidence: 89%

“…In addition, the best MultiPoint pacing improved acute diastolic function, i.e., change from baseline. 27 In 2015, Pappone published 12-month …”

Section: The Proportion Of Patients Who Exhibited Improvements In Lvomentioning

confidence: 99%

“…As previously discussed, numerous studies have demonstrated the acute and mid-term benefits of MultiPoint pacing in improving electrical propagation, acute haemodynamics and dyssynchrony. [25][26][27][28][35][36][37] anatomical spacing between LV1 and LV2 cathodes resulted in the best dP/dt response more often than an electrical delay-based selection method. Moreover, pacing with 5 ms LV1-LV2 delay produced the best dP/dt response more often than pacing with 40 ms LV1-LV2.…”

mentioning

confidence: 93%

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Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

Curnis¹,

O’Donnell²,

Kloppe³

et al. 2015

Arrhythmia &Amp; Electrophysiology Review

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Cardiac resynchronisation therapy (CRT) using biventricular pacing is an established therapy for impairment of left ventricular (LV) systolic function in patients with heart failure (HF). Although technological advances have improved outcomes in patients undergoing biventricular pacing, the optimal placement of pacing leads remains challenging, and approximately one third of patients have no response to CRT. This may be due to patient selection and lead placement. Electrical mapping can greatly improve outcomes in CRT and increase the number of patients who derive benefit from the procedure. MultiPoint™ pacing (St Jude Medical, St Paul, MN, US) using a quadripolar lead increases the possibility of finding the best pacing site. In clinical studies, use of MultiPoint pacing in HF patients undergoing CRT has been associated with haemodynamic and clinical benefits compared with conventional biventricular pacing, and these benefits have been sustained at 12 months. This article describes the proceedings of a satellite symposium held at the European Heart Rhythm Association (EHRA) Europace conference held in Milan, Italy, in June 2015.

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mentioning

confidence: 89%

“…In addition, the best MultiPoint pacing improved acute diastolic function, i.e., change from baseline. 27 In 2015, Pappone published 12-month …”

Section: The Proportion Of Patients Who Exhibited Improvements In Lvomentioning

confidence: 99%

mentioning

confidence: 93%

See 1 more Smart Citation

Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

Curnis¹,

O’Donnell²,

Kloppe³

et al. 2015

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

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“…19 Additionally, our recent work has suggested mid-term improvement in LV reverse remodelling and LV function with MPP over conventional CRT. 13 However, previous evaluations of MPP have focussed on patients receiving de novo CRT implants. In this study, we evaluated the role of programming settings to deliver MPP in patients already receiving conventional CRT and observed further improvements in LV ESV and LV EF beyond that seen with conventional CRT.…”

Section: Multipointmentioning

confidence: 99%

“…10 After randomization to receive biventricular pacing with MPP or conventional CRT optimized by PV loop measurements, mid-term follow-up results showed greater reduction in LV ESV and improvement in LV EF in the MPP group. 13 While prior studies of MPP delivered from a single CS branch have focussed on de novo CRT implants, the effect of adding a second LV pacing site to patients with a previously implanted CRT system has been evaluated in the V3 trial. 20 Non-responders to conventional CRT for at least 6 months were randomized to receive triple-site ventricular pacing with the addition of a second LV lead or continue with conventional biventricular pacing.…”

Section: Multipointmentioning

confidence: 99%

Multipoint left ventricular pacing provides additional echocardiographic benefit to responders and non-responders to conventional cardiac resynchronization therapy

Pappone

Ćalović

Cuko

et al. 2015

European Heart Journal Supplements

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Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing [MultiPoint TM Pacing (MPP), St. Jude Medical, Sylmar, CA, USA] improves LV function and clinical response relative to conventional CRT in patients receiving a de novo device implant. We hypothesized that patients with a previously implanted conventional CRT device would receive additional benefit by switching to MPP. Patients receiving a CRT implant (Unify Quadra MP TM or Quadra Assura MP TM CRT-D and Quartet TM LV lead, St. Jude Medical) were programmed to conventional CRT (i.e. biventricular pacing with right ventricular and single LV sites) optimized by intraoperative haemodynamic measurements. After 12 months of conventional therapy, patients were reprogrammed to MPP and reevaluated at 16 months post-implant. Response to CRTwas prospectively defined as reduction in end-systolic volume (ESV) of ≥15% relative to baseline as determined by a blinded observer. Eight patients with an implanted CRT device [New York Heart Association III, ejection fraction (EF) 30 + 5%, QRS 149 + 18 ms] received 12 months of conventional CRTand were switched to MPP. After 12 months of conventional CRT, ESV reduction and EF increase relative to baseline were 218 + 12 and +5 + 4%, respectively, and six of eight (75%) patients were considered CRTresponders. After 4 months of MPP, two of two (100%) patients classified as non-responders to conventional CRT became responders with additional reduction in ESV of 233 and 220% and improvement in EF of +15 and +4%. The remaining six patients classified as responders experienced additional reduction in ESVof 213 + 21% and improvement in EF of +7 + 7% after switching to MPP. Multipoint LV pacing may provide additional improvement to LV function in patients receiving conventional CRT.

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Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy

Zhu

Chen

Fulati

et al. 2019

J of Clinical Ultrasound

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Purpose To evaluate the acute effect of multipoint pacing (MPP) and search for the better baseline predictors of response to MPP for guiding patient selection. Methods We enrolled 46 heart failure patients scheduled for implantation of MPP‐enabled cardiac resynchronization therapy (CRT) devices. An acute pacing protocol including conventional CRT and MPP pacing configurations was performed after implantation. Echocardiography was used at baseline and during pacing test, and response was defined as left ventricular (LV) end‐systolic volume (ESV) reduction ≥ 15% at 6‐month follow‐up. Results MPP response was present in 32 (69%) patients. Responders showed significantly superior LV ejection fraction, global longitudinal peak strain (GLPS), and mechanical dispersion (MD) with MPP than with conventional CRT (all P < 0.05). Baseline GLPS (OR 1.524; 95% CI 1.031‐2.251; P = 0.034) and MD (OR 1.048; 95% CI 1.016‐1.081; P = 0.003) were independent predictors of MPP response in multivariate regression analysis. Both |GLPS| and MD were significantly correlated with percentage change in LVESV (▵LVESV%) at 6‐month follow‐up (r = 0.731 and r = 0.696, respectively; all P < 0.001). |GLPS| ≥ 5.0% combined with MD ≥ 120 ms predicted MPP response with the optimal sensitivity of 91% and specificity of 71% (AUC = 0.848, P < 0.001). Conclusions MPP tends to be superior to conventional CRT in improving acute response. |GLPS| and MD can successfully predict response to MPP, and their combination can further improve the prediction accuracy of response.

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Multipoint Left Ventricular Pacing in a Single Coronary Sinus Branch Improves Mid‐Term Echocardiographic and Clinical Response to Cardiac Resynchronization Therapy

Abstract: PV loop optimized BiV pacing with MPP resulted in an improved rate of response to CRT.

Cited by 52 publications

References 32 publications

Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

Multipoint left ventricular pacing provides additional echocardiographic benefit to responders and non-responders to conventional cardiac resynchronization therapy

Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy

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