Peter Lercher1, Maurizio Lunati2, Roberto Rordorf3, Maurizio Landolina4, Nima Badie5, Fujian Qu5, Cyrille Casset5, Kyungmoo Ryu5, Stefano Ghio3, Jagmeet P Singh6, Christophe Leclercq7. 1. Department of Cardiology, Medical University Graz, Graz, Austria. 2. Cardiac Department, Niguarda Ca' Granda, Granda Hospital, Milan, Italy. 3. Cardiac Department, Policlinico San Matteo, Pavia, Italy. 4. Cardiac Department, Policlinico San Matteo, Pavia, Italy; Cardiology Department, Ospedale Maggiore di Crema, Crema, Italy. 5. Abbott, Abbott Park, Illinois. 6. Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 7. Department of Cardiology, University Hospital of Rennes, Rennes, France. Electronic address: christophe.leclercq@chu-rennes.fr.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint Pacing [MPP]) improves acute hemodynamics and chronic outcomes in comparison to conventional biventricular pacing (BiV), though MPP programming questions persist. OBJECTIVES: In this multicenter feasibility study, we evaluated the feasibility of using noninvasive systolic blood pressure (SBP) to guide MPP programming and assessed the chronic 6-month echocardiographic CRT response. METHODS: Patients implanted with MPP-enabled CRT-defibrillator devices underwent noninvasive hemodynamic assessment (finger arterial pressure) during a pacing protocol that included atrial-only pacing and various BiV and MPP configurations. Each configuration was repeated 4 times, alternating with a reference pacing configuration, to calculate the SBP difference relative to reference (ΔSBP). CRT configurations with the greatest ΔSBP were programmed. An independent core laboratory analyzed baseline and 6-month echocardiograms, with CRT response defined as a 6-month reduction in LV end-systolic volume ≥ 15%. RESULTS: Forty-two patients (71% male; LV ejection fraction 30.3% ± 7.5%; QRS duration 161 ± 19 ms; 26% had ischemic cardiomyopathy) were enrolled in 4 European centers. Relative to atrial-only pacing, the best BiV and best MPP configurations produced significant SBP elevations of 3.1 ± 4.2 (P < .01) and 4.1 ± 4.1 mm Hg (P < .01), respectively (BiV vs MPP; P < .01). Greater SBP elevations were associated with the best MPP compared with the best BiV configurations in 29 of 37 patients completing the pacing protocol (78%). Of MPP-programmed patients completing the 6-month follow-up visit, 23 of 27 (85%) were classified as CRT responders (6-month reduction in LV end-systolic volume 37.0% ± 13.6%). CONCLUSION: Acute noninvasive hemodynamics after CRT device implantation predominantly favored MPP over BiV programming. MPP programming guided by noninvasive hemodynamics resulted in positive LV structural remodeling.
BACKGROUND: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint Pacing [MPP]) improves acute hemodynamics and chronic outcomes in comparison to conventional biventricular pacing (BiV), though MPP programming questions persist. OBJECTIVES: In this multicenter feasibility study, we evaluated the feasibility of using noninvasive systolic blood pressure (SBP) to guide MPP programming and assessed the chronic 6-month echocardiographic CRT response. METHODS:Patients implanted with MPP-enabled CRT-defibrillator devices underwent noninvasive hemodynamic assessment (finger arterial pressure) during a pacing protocol that included atrial-only pacing and various BiV and MPP configurations. Each configuration was repeated 4 times, alternating with a reference pacing configuration, to calculate the SBP difference relative to reference (ΔSBP). CRT configurations with the greatest ΔSBP were programmed. An independent core laboratory analyzed baseline and 6-month echocardiograms, with CRT response defined as a 6-month reduction in LV end-systolic volume ≥ 15%. RESULTS: Forty-two patients (71% male; LV ejection fraction 30.3% ± 7.5%; QRS duration 161 ± 19 ms; 26% had ischemic cardiomyopathy) were enrolled in 4 European centers. Relative to atrial-only pacing, the best BiV and best MPP configurations produced significant SBP elevations of 3.1 ± 4.2 (P < .01) and 4.1 ± 4.1 mm Hg (P < .01), respectively (BiV vs MPP; P < .01). Greater SBP elevations were associated with the best MPP compared with the best BiV configurations in 29 of 37 patients completing the pacing protocol (78%). Of MPP-programmed patients completing the 6-month follow-up visit, 23 of 27 (85%) were classified as CRT responders (6-month reduction in LV end-systolic volume 37.0% ± 13.6%). CONCLUSION: Acute noninvasive hemodynamics after CRT device implantation predominantly favored MPP over BiV programming. MPP programming guided by noninvasive hemodynamics resulted in positive LV structural remodeling.
Authors: Maciej Sterliński; Joanna Zakrzewska-Koperska; Aleksander Maciąg; Adam Sokal; Joaquin Osca-Asensi; Lingwei Wang; Vasiliki Spyropoulou; Baerbel Maus; Francesca Lemme; Osita Okafor; Berthold Stegemann; Richard Cornelussen; Francisco Leyva Journal: Front Cardiovasc Med Date: 2022-05-12
Authors: Luuk I B Heckman; Marion Kuiper; Frederic Anselme; Filippo Ziglio; Nicolas Shan; Markus Jung; Stef Zeemering; Kevin Vernooy; Frits W Prinzen Journal: Heart Rhythm O2 Date: 2020-06-15
Authors: Abdulmohsen Almusaad; Raed Sweidan; Haitham Alanazi; Abdelrahman Jamiel; Fayez Bokhari; Yahya Al Hebaishi; Ahmed Al Fagih; Najib Alrawahi; Amjad Al-Mandalawi; Mohamed Hashim; Bandar Al Ghamdi; Mohammad Amin; Mohamed Elmaghawry; Naeem Al Shoaibi; Antonio Sorgente; Maria Loricchio; Ghaliah AlMohani; Ismail Al Abri; Edmon Benjamin; Nazar Sudan; Alexandre Chami; Nima Badie; Mohammed Sayed; Ahmad Hersi Journal: J Interv Card Electrophysiol Date: 2021-06-22 Impact factor: 1.900