title: In Heart Failure Patients with Left Bundle Branch Block Single Lead MultiSpot Left Ventricular Pacing Does Not Improve Acute Hemodynamic Response To Conventional Biventricular Pacing. A Multicenter Prospective, Interventional, Non-Randomized Study.
abstract: Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive.
  
  
  
  The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV).
  
  
  
  Patients with left bundle branch block (LBBB) underwent an acute hemodynamic study to determine the %change in LV+dP/dtmax from baseline atrial pacing compared to the following configurations: BiV pacing with the LV lead in a one of lateral veins, while pacing from the distal, mid, or proximal electrode and all 3 electrodes together (i.e. MSP). All measurements were repeated 4 times at 5 different atrioventricular delays. We also measured QRS-width and individual Q-LV durations.
  
  
  
  Protocol was completed in 24 patients, all with LBBB (QRS width 171±20 ms) and 58% ischemic aetiology. The percentage change in LV+dP/dtmax for MSP pacing was 31.0±3.3% (Mean±SE), which was not significantly superior to any BiV pacing configuration: 28.9±3.2% (LV-distal), 28.3±2.7% (LV-mid), and 29.5±3.0% (LV-prox), respectively. Correlation between LV+dP/dtmax and either QRS-width or Q-LV ratio was poor.
  
  
  
  In patients with LBBB MultiSPOT LV pacing demonstrated comparable improvement in contractility to best conventional BiV pacing. Optimization of atrioventricular delay is important for the best performance for both BiV and MultiSPOT pacing configurations.
  
  
  
  ClinicalTrials.gov NTC01883141.
authors.affiliation: The Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Sterliński
authors.affiliation: Department of Cardiology,Congenital Heart Diseases and Electrotherapy Silesian Center of Heart Disease, Zabrze, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Sokal
authors.affiliation: Department of Cardiology,Congenital Heart Diseases and Electrotherapy Silesian Center of Heart Disease, Zabrze, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
authors.affiliation: Heart Center, Ghent University Hospital, Ghent, Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: Van Heuverswyn
authors.affiliation: Guys and St Thomas NHS Trust, St Thomas Hospital, London, England.
authors.forename: C Aldo
authors.initials: CA
authors.lastname: Rinaldi
authors.affiliation: Onze-Lieve-Vrouwziekenhuis Aalst, Aalst,Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Vanderheyden
authors.affiliation: Cardiac Electrophysiology Unit, Barzilai Medical Center, Ashkelon, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khalameizer
authors.affiliation: Faculty of Medicine, Imperial College Healthcare NHS Trust, London, England.
authors.forename: Darrel
authors.initials: D
authors.lastname: Francis
authors.affiliation: Bakken Research Center, Medtronic, Maastricht, The Netherlands.
authors.forename: Joeri
authors.initials: J
authors.lastname: Heynens
authors.affiliation: Bakken Research Center, Medtronic, Maastricht, The Netherlands.
authors.forename: Berthold
authors.initials: B
authors.lastname: Stegemann
authors.affiliation: Bakken Research Center, Medtronic, Maastricht, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Cornelussen
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016277:Ventricular Function, Left