title: Haemodynamic effects of cardiac resynchronization therapy using single-vein, three-pole, multipoint left ventricular pacing in patients with ischaemic cardiomyopathy and a left ventricular free wall scar: the MAESTRO study.
abstract: OBJECTIVE
  The clinical response to cardiac resynchronization therapy (CRT) is variable. Multipoint left ventricular (LV) pacing could achieve more effective haemodynamic response than single-point LV pacing. Deployment of an LV lead over myocardial scar is associated with a poor haemodynamic response to and clinical outcome of CRT. We sought to determine whether the acute haemodynamic response to CRT using three-pole LV multipoint pacing (CRT3P-MPP) is superior to that to conventional CRT using single-site LV pacing (CRTSP) in patients with ischaemic cardiomyopathy and an LV free wall scar.
  
  
  RESULTS
  Sixteen patients with ischaemic cardiomyopathy [aged 72.6 ± 7.7 years (mean ± SD), 81.3% male, QRS: 146.0 ± 14.2 ms, LBBB in 14 (87.5%)] in whom the LV lead was intentionally deployed straddling an LV free wall scar (assessed using cardiac magnetic resonance), underwent assessment of LV + dP/dtmax during CRT3P-MPP and CRTSP. Interindividually, the ΔLV + dP/dtmax in relation to AAI pacing with CRT3P-MPP (6.2 ± 13.3%) was higher than with basal and mid CRTSP (both P < 0.001), but similar to apical CRTSP. Intraindividually, significant differences in the ΔLV + dP/dtmax to optimal and worst pacing configurations were observed in 10 (62.5%) patients. Of the 8 patients who responded to at least one configuration, CRT3P-MPP was optimal in 5 (62.5%) and apical CRTSP was optimal in 3 (37.5%) (P = 0.0047).
  
  
  CONCLUSIONS
  In terms of acute haemodynamic response, CRT3P-MPP was comparable an apical CRTSP and superior to basal and distal CRTSP. In the absence of within-device haemodynamic optimization, CRT3P-MPP may offer a haemodynamic advantage over a fixed CRTSP configuration.
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Fraz
authors.initials: F
authors.lastname: Umar
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Taylor
authors.affiliation: Bakken Research Centre, Medtronic, Inc., Maastricht, The Netherlands.
authors.forename: Berthold
authors.initials: B
authors.lastname: Stegemann
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Howard
authors.initials: H
authors.lastname: Marshall
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Flannigan
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Mauro
authors.initials: M
authors.lastname: Lencioni
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: De Bono
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Griffith
authors.affiliation: Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B4 7ET, UK f.leyva@aston.ac.uk.
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D009202:Cardiomyopathies / Q000150:complications*; D002921:Cicatrix / Q000150:complications*; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications*; D006113:United Kingdom; D016277:Ventricular Function, Left
keywords: Cardiac resynchronization therapy; Haemodynamics; Multipoint pacing; Multipolar leads