Characterization of ventricular activation pattern and acute hemodynamics during multipoint left ventricular pacing.
BACKGROUND
Multipoint left ventricular (LV) pacing (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) in a single coronary sinus branch has been introduced as a novel means of cardiac resynchronization therapy (CRT). It is speculated that MPP improves LV function by capturing a larger LV tissue area, resulting in uniform wavefront propagation throughout the ventricles, in comparison to conventional biventricular pacing (BIV).


OBJECTIVE
The purpose of this study was to evaluate MPP by means of contact mapping and hemodynamic measures to understand the underlying mechanisms and effects.


METHODS
Ten patients with non-ischemic cardiomyopathy (mean age 69 ± 9 years; 6 men (60%); New York Heart Association heart failure class II or III; QRS duration 173 ± 20 ms; LV ejection fraction 27% ± 5%) received a CRT-defibrillator capable of MPP. After the implantation procedure, an acute pacing protocol was implemented, including 2 BIV and up to 9 MPP interventions. In all pacing interventions, LV electrical activation patterns and hemodynamics (dP/dtmax) were evaluated, and for each patient, both the resulting measures were compared between MPP and BIV interventions.


RESULTS
Compared with BIV, MPP resulted in an increase in LV dP/dtmax (30% ± 13% vs. 25% ± 11%; P = .041), a reduction in QRS duration (22% ± 11% vs. 11% ± 11%; P = .01), and a decrease in total endocardial activation time (25% ± 15% vs. 10% ± 20%; P = .01). MPP resulted in a larger capture of LV mass during the first 25 ms (35% ± 22% vs. 16% ± 8%; P = .005) and during the first 50 ms (78% ± 27% vs. 60% ± 23%; P = .03) of pacing, suggesting a quicker wavefront propagation throughout the left ventricle.


CONCLUSIONS
In this acute study, MPP in CRT improved both endocardial and surface electrical parameters and hemodynamics in comparison with BIV.
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Endrj
E
Menardi
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Gian Paolo
GP
Ballari
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Cecilia
C
Goletto
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Guido
G
Rossetti
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy. Electronic address: vado.a@ospedale.cuneo.it.
Antonello
A
Vado
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D009202:Cardiomyopathies / Q000150:complications* / Q000000981:diagnostic imaging; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Activation time; Cardiac resynchronization therapy; Heart failure; Hemodynamics; MultiPoint Pacing; Surface ECG