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

Abstract

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.

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

“…At the same time, it improves cardiac contractility, as evaluated by means of the increase in dP/dtmax. 10 In this set of patients with homogeneous substrate and absence of scar, the correlation found between both QRSd and dP/dtmax and between QRSd and TAT suggests that it could be possible to optimize the MPP delays without invasive assessments, using QRSd changes, which is in line with the study findings of Zanon et al 16 In particular, our data suggest that once established the sequence of LV pacing (distal to proximal or vice versa, according to the latest site provided by RV-LV Conduction Time Measurement), the best pacing configuration, in terms of hemodynamics and/or waveform speed propagation, was chosen among the MPP choices. In addition, the best total VV delay (Δ1 þ Δ2) during MPP seems to be the minimum available from the device (Δ1 ¼ 5 ms; Δ2 ¼ 5 ms), especially in patients with LBBB (6 of 6), while QuickOpt algorithm failed to predict it.…”

Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

“…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. A clinical benefit was also seen: improvement of more than two NYHA classes was Figure 4).…”

“…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.…”

Managing Non-responders Today and What’s on the Horizon

“…In a study of the relationship between qLV and hemodynamics, dP/dt was assessed acutely in a patient population undergoing CRT. 12 The relationship between qLV and hemodynamics was almost linear, so the ability to reach for the latest site of electrical activation had significant effect on CRT response in terms of hemodynamics. This is dependent on the availability of coronary sinus tributaries in which to deliver the lead.…”

“…With a quadripolar lead, we have the ability to simultaneously pace different vectors on this lead platform. Zanon and colleagues 12 showed that QRS duration was significantly abbreviated by MultiPointt Pacing (MPP) (St. Jude Medical, Sylmar, CA) compared with standard BiV pacing. In fact, compared with BiV pacing at any LV site, MultiPointt Pacing (MPP) (St. Jude Medical, Sylmar, CA) yielded a small but consistent contractility increase, which was correlated with greater QRS narrowing, again emphasizing that electrical resynchronization is an important component of increasing response.…”