title: Multisite Pacing for Cardiac Resynchronization Therapy: Promise and Pitfalls.
abstract: Cardiac resynchronization therapy (CRT) reduces the morbidity and mortality of patients with symptomatic heart failure and intraventricular conduction delay. However, its clinical outcomes are non-uniform and up to one third of treated patients are subsequently classified as non-responders. Multisite pacing (MSP), i.e. stimulating the myocardium from multiple locations, has emerged as a potential therapeutic option in patients requiring CRT. The rationale for MSP is based on the hypothesis that increasing the pacing locations in the left ventricle results in a more physiologic and coordinated myocardial systole. MSP can be achieved by additional leads in the right or left ventricle but this can lead to high battery drain and more frequent generator replacements. Multipolar left ventricular leads can deliver pacing at multiple sites, and therefore, a single lead can be used for MSP. However, the optimal programming settings and the outcomes of this approach remain yet to be determined.
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK. aantoniadis@gmail.com.
authors.forename: Antonios P
authors.initials: AP
authors.lastname: Antoniadis
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Behar
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Claridge
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
authors.forename: Christopher Aldo
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000639:trends; D058409:Cardiac Resynchronization Therapy Devices; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy
keywords: Biventricular pacing; Cardiac resynchronization therapy; Dyssynchrony; Heart failure; Multipolar left ventricular leads; Multisite pacing