title: Acute effects of multisite left ventricular pacing on mechanical dyssynchrony in patients receiving cardiac resynchronization therapy.
abstract: BACKGROUND
  A novel quadripolar left ventricular (LV) pacing lead has the ability to deliver multisite LV pacing (MSLV). We set out to characterize the safety and changes in acute mechanical dyssynchrony with MSLV in cardiac resynchronization therapy (CRT) patients.
  
  
  RESULTS
  Prospective multicenter study in 52 patients receiving CRT. An acute pacing protocol comprising 8 MSLV configurations covering a range of delays was compared with conventional CRT (baseline). Transthoracic tissue Doppler imaging (TDI) was used to measure the standard deviation of time to peak contraction of 12 LV segments (Ts-SD) and delayed longitudinal contraction. No ventricular arrhythmia occurred in any of the 52 patients. Complete TDI datasets were collected in 41 patients. Compared with baseline: 1) The mean Ts-SD was significantly lower for the optimal MSLV configuration (35.3 ± 36.4 vs 50.2 ± 29.1 ms; P < .001); 2) at least 1 MSLV configuration exhibited a significant dyssynchrony improvement in 63% of patients; and 3) the mean number of LV segments with delayed longitudinal contractions was significantly reduced with the optimal MSLV configuration (0.37 ± 7.99 vs 2.20 ± 0.19; P < .001).
  
  
  CONCLUSIONS
  Acute MSLV was acutely safe, and a proportion of MSLV vectors resulted in a significant reduction in echocardiographic dyssynchrony compared with conventional CRT.
authors.affiliation: St Thomas Hospital, London, United Kingdom. Electronic address: c.rinaldi@virgin.net.
authors.forename: C Aldo
authors.initials: CA
authors.lastname: Rinaldi
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kranig
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
authors.forename: Tim
authors.initials: T
authors.lastname: Betts
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Anoop
authors.initials: A
authors.lastname: Shetty
authors.forename: Allen
authors.initials: A
authors.lastname: Keel
authors.forename: Kyungmoo
authors.initials: K
authors.lastname: Ryu
authors.forename: Taraneh G
authors.initials: TG
authors.lastname: Farazi
authors.forename: Marcus
authors.initials: M
authors.lastname: Simon
authors.forename: Tasneem Z
authors.initials: TZ
authors.lastname: Naqvi
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Cardiac resynchronization therapy; biventricular pacing; dyssynchrony; heart failure; left ventricular pacing leads; multisite pacing