title: A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study.
abstract: OBJECTIVE
  Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead.
  
  
  RESULTS
  Fifteen patients with a previously implanted CRT system received a second temporary CS lead and left ventricular (LV) endocardial catheter. A pressure wire and non-contact mapping array were placed into the LV cavity to measure LVdP/dtmax and perform electroanatomical mapping. Conventional CRT, BV-Endo, and MSP were then performed (MSP-1 via two epicardial leads and MSP-2 via a single-quadripolar lead). The best overall AHR was found using BV-Endo pacing with a 19.6 ± 13.6% increase in AHR at the optimal endocardial site over baseline (P < 0.001). There was an increase in LVdP/dtmax with MSP-1 and MSP-2 compared with conventional CRT, but this was not statistically significant. Biventricular endocardial pacing from the optimal site was significantly superior to conventional CRT (P = 0.039). The AHR achieved when BV-Endo pacing was highly site specific. Within individuals, the best pacing modality varied and was affected by the underlying substrate. Left ventricular activation times did not predict the optimal haemodynamic configuration.
  
  
  CONCLUSIONS
  Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate.
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK anoopshetty@doctors.org.uk.
authors: Anoop K
authors: AK
authors: Shetty
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Manav
authors: M
authors: Sohal
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Zhong
authors: Z
authors: Chen
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Matthew R
authors: MR
authors: Ginks
authors: Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Julian
authors: J
authors: Bostock
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Sana
authors: S
authors: Amraoui
authors: Cardiac Rhythm Management Division, St Jude Medical, Sylmar, CA, USA.
authors: Kyungmoo
authors: K
authors: Ryu
authors: Cardiac Rhythm Management Division, St Jude Medical, Sylmar, CA, USA.
authors: Stuart P
authors: SP
authors: Rosenberg
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK.
authors: Steven A
authors: SA
authors: Niederer
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Jas
authors: J
authors: Gill
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: Gerry
authors: G
authors: Carr-White
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK.
authors: Reza
authors: R
authors: Razavi
authors: Department of Imaging Sciences, Rayne Institute, Kings College London, London SE1 7EH, UK Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor, East Wing, St Thomas' Hospital, SE1 7EH London, UK.
authors: C Aldo
authors: CA
authors: Rinaldi
mesh_terms: D018780:Body Surface Potential Mapping / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000145:classification / Q000379:methods*; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control
keywords: Cardiac resynchronization therapy; Electrophysiology mapping; Haemodynamics; Multisite pacing