title: Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients.
abstract: BACKGROUND
  Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics.
  
  
  OBJECTIVE
  To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients.
  
  
  METHODS
  Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention.
  
  
  RESULTS
  Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing -dP/dtmin (-13.5% ± 10.2% vs -10.6% ± 6.8%; P = .011), relaxation time constant (-7.5% ± 9.0% vs -4.8% ± 7.2%; P = .012), and end-diastolic pressure (-18.2% ± 22.4% vs -8.7% ± 21.4%; P < .001) as compared with the best CONV intervention.
  
  
  CONCLUSIONS
  CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV.
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. Electronic address: cpappone@gvmnet.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Žarko
authors.initials: Ž
authors.lastname: Ćalović
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vicedomini
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Amarild
authors.initials: A
authors.lastname: Cuko
authors.affiliation: St Jude Medical, Sylmar, California.
authors.forename: Luke C
authors.initials: LC
authors.lastname: McSpadden
authors.affiliation: St Jude Medical, Sylmar, California.
authors.forename: Kyungmoo
authors.initials: K
authors.lastname: Ryu
authors.affiliation: St Jude Medical, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Romano
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Saviano
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Baldi
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pappone
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Ciaccio
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Giannelli
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Ionescu
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Petretta
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Vitale
authors.affiliation: Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy.
authors.forename: Angelica
authors.initials: A
authors.lastname: Fundaliotis
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Heart failure; Hemodynamics; MultiPoint Pacing; Pressure-volume loops