Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients

Carlo Pappone, Žarko Ćalović, Gabriele Vicedomini, Amarild Cuko, Luke C. McSpadden, Kyungmoo Ryu, Enrico Romano, Massimo Saviano, Mario Baldi, Alessia Pappone, Cristiano Ciaccio, Luigi Giannelli, Bogdan Ionescu, Andrea Petretta, Raffaele Vitale, Angelica Fundaliotis, Luigi Tavazzi, Vincenzo Santinelli

Research output: Contribution to journalArticlepeer-review

Abstract

Backgound Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics. Objective To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients. Methods Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention. Results Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax; 15.9% ± 10.0% vs 13.5% ± 8.8%; P min (-13.5% ± 10.2% vs -10.6% ± 6.8%; P =.011), relaxation time constant (-7.5% ± 9.0% vs -4.8% ± 7.2%; P =.012), and end-diastolic pressure (-18.2% ± 22.4% vs -8.7% ± 21.4%; P

Original languageEnglish
Pages (from-to)394-401
Number of pages8
JournalHeart Rhythm
Volume11
Issue number3
DOIs
Publication statusPublished - Mar 2014

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Hemodynamics
  • MultiPoint Pacing
  • Pressure-volume loops

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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