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Osca J, Francisco-Pascual J, Martínez-Basterra J, Martínez JG, Reis H, Oliveira M, Campos B, Balaguer J, Rubio J, Pavón-Jiménez R, Hernández J, Ormaetxe JM, Zamorano JL, Santamaría P, Alzueta J. Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III. Eur J Clin Invest 2023; 53:e13935. [PMID: 36504276 DOI: 10.1111/eci.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
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Affiliation(s)
- Joaquín Osca
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Jaume Francisco-Pascual
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | | | | | | | | | - Bieito Campos
- Hospital Universitari Arnau de Vilanova de Lleida, Barcelona, Spain
| | - Javier Balaguer
- Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Julio Hernández
- Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Abstract
After decades of clinical use, cardiac resynchronization therapy (CRT) can be considered an established therapy. However, there are multiple open questions to be addressed that shall further improve the proportion of patients responding to CRT. Progress in better understanding the relationship between electrical and mechanical disorder in patients with heart failure with ventricular conduction abnormalities is important. This article presents and discusses ongoing studies in different areas of CRT research, including patient selection by novel diagnostic tools, extension of clinical criteria, left ventricular lead positioning and pacing site selection, optimization of CRT delivery and programming, and selection of device type.
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Affiliation(s)
- Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland.
| | - Tardu Özkartal
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland
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Jain SK, Saba S. Multisite Left Ventricular Pacing in Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2022; 14:253-261. [PMID: 35715083 DOI: 10.1016/j.ccep.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment of patients with heart failure with reduced ejection fraction and prolonged ventricular depolarization on surface electrocardiogram. Although patients' characteristics, such as their type of cardiomyopathy and the morphology and width of their baseline QRS complex, have been associated with CRT response, these features are not modifiable. Left ventricular multisite pacing has been proposed and tested as a tool to improve response to CRT and positively impact patient outcomes. This article reviews the published literature on left ventricular multisite pacing, with focus on the results of recently presented or published clinical trials.
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Affiliation(s)
- Sandeep K Jain
- Cardiac Electrophysiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, South Tower E352.6, Pittsburgh, PA 15213, USA
| | - Samir Saba
- Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, South Tower E355.6, Pittsburgh, PA 15213, USA.
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Wada M, Kondo H, Fukuda T, Sato H, Yamasaki H, Yonezu K, Uemura T, Ogawa N, Saito S, Shuto T, Wada T, Yufu K, Nobe S, Miyamoto S, Takahashi N. Potential efficacy of multipoint pacing in the reduction of mitral regurgitation volume: a case report. ESC Heart Fail 2022; 9:2724-2727. [PMID: 35481626 PMCID: PMC9288779 DOI: 10.1002/ehf2.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
A 70‐year‐old woman who had cardiac sarcoidosis and severe tethering mitral regurgitation (MR) and had been implanted with a biventricular pacemaker experienced recurrent hospitalisation due to decompensated heart failure (HF). Application of MultiPoint™ pacing reduced the MR volume and maintained the symptoms under control; however, the predicted longevity of the device significantly decreased because of the very high threshold of the added pacing site. Transcatheter mitral valve repair (TMVR) using MitraClip® was performed to further diminish the severe MR, thereby enabling the switch from highly consumptive multipoint pacing (MPP) to energy‐saving single‐point pacing. MPP could further reduce MR compared to the conventional single‐point pacing, and this could be a bridging therapy to TMVR in some patients implanted with a biventricular pacemaker. This is the first case to report that switching from conventional single‐point pacing to MPP decreased the MR, to some extent, resulting in the improvement of HF symptoms.
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Affiliation(s)
- Masato Wada
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroki Sato
- Department of Internal Medicine, Kunisaki City Hospital, Kunisaki, Japan
| | - Hirochika Yamasaki
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tetsuya Uemura
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Naoko Ogawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Shotaro Saito
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tomoyuki Wada
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Seiki Nobe
- Department of Internal Medicine, Kunisaki City Hospital, Kunisaki, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
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5
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Hua W, Cai L, Su Y, Xu W, Shen F, Wang J, Gu M, Badie N, Jiang C, Zhang S. Acute Hemodynamic Impact of Atrioventricular Delay and Left Ventricular Pacing Vector Programming in MultiPoint Pacing. Pacing Clin Electrophysiol 2022; 45:649-657. [PMID: 35306672 DOI: 10.1111/pace.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Wei Hua
- Fuwai Hospital CAMS & PUMC Beijing China
| | - Lin Cai
- The Third People's Hospital of Chengdu Chengdu China
| | - Yangang Su
- Shanghai Zhongshan Hospital Shanghai China
| | - Wei Xu
- Gulou Hospital Nanjing China
| | | | | | - Min Gu
- Fuwai Hospital CAMS & PUMC Beijing China
| | | | | | - Shu Zhang
- Fuwai Hospital CAMS & PUMC Beijing China
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Anodal Capture for Multisite Pacing with a Quadripolar Left Ventricular Lead: A Feasibility Study. J Clin Med 2021; 10:jcm10245886. [PMID: 34945180 PMCID: PMC8707912 DOI: 10.3390/jcm10245886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Up to 40% of patients are CRT non-responders. Multisite pacing, using a unique quadripolar lead, also called multipoint/multipole pacing (MPP), is a potential alternative. We sought to determine the feasibility of intentional anodal capture using a single LV quadripolar lead, to reproduce MPP without the need of a specific algorithm (so-called “pseudo MPP”). Methods: Consecutive patients implanted with a commercially available CRT device and a quadripolar LV lead in our department were prospectively included. The electric charge (Q, in Coulomb) of RV and LV pacing spikes were calculated for all available LV pacing configurations at the threshold. The best MPP was defined as the configuration with the lowest consumption (QRV + Qbest LV1 + Qbest LV2). The best “pseudo MPP” (QRV + QLV1–LV2 with anodal capture) and best BVp (QRV + Qbest LV) were also calculated. A theoretical longevity was estimated for each configuration at the threshold without a safety margin. Results: A total of 235 configurations were tested in 15 consecutive patients. “Pseudo-MPP” was feasible in 80% of patients with 3.1 ± 2.6 vectors available per-patient and LVproximal-LVdistal (most distant electrodes) vectors were available in 47% of patients. Each MPP pacing spike electrical charge was comparable to “pseudo-MPP” (18,428 ± 6863 µC and 20,528 ± 5509 µC, respectively, p = 0.15). Theoretical longevity was 6.2 years for MPP, 5.6 years for “pseudo-MPP” and 13.7 years for BVp. Conclusions: “Pseudo MPP” using intentional anodal capture with a quadripolar left ventricular lead, mimicking conventional multisite pacing, is feasible in most of CRT patients, with comparable energy consumption. Further studies on their potential clinical impact are needed.
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Fyenbo DB, Park Frausing MHJ, Kronborg MB. Bipolar versus quadripolar left ventricular leads for cardiac resynchronization therapy: evidence to date. Expert Rev Cardiovasc Ther 2021; 19:1075-1084. [PMID: 34865590 DOI: 10.1080/14779072.2021.2013813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In cardiac resynchronization therapy (CRT) devices, transvenous left ventricular (LV) leads are more prone to instability, high pacing thresholds, and phrenic nerve stimulation (PNS) that may necessitate lead revision, replacement in a suboptimal position, or deactivation of the lead. To overcome some of these challenges, quadripolar (QP) LV leads have been developed and accounted for over 90% of implanted LV leads 5 years after they were introduced. AREAS COVERED This review provides an overview of the current evidence of implanting QP leads in CRT as compared with traditional bipolar (BP) leads including details about feasibility, safety and lead performance, clinical outcome and cost-effectiveness. EXPERT OPINION Based on the current literature, implantation with a QP lead decreases revision rates but does not affect any clinical outcomes including mortality, hospitalization, symptoms, or echocardiographic parameters. Feasibility and stability do not differ between QP and BP leads. A QP lead should be preferred as first choice over a BP lead due to lower rates of PNS and lower pacing thresholds leading to less frequent lead revisions and battery replacements. In addition, this strategy may be cost saving despite a higher price of QP leads.
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Affiliation(s)
- Daniel Benjamin Fyenbo
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmar
| | - Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmar
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmar
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Nagase T, Ishiguro M, Mabuchi K, Seki R, Asano S, Fukunaga H, Inoue K, Sekiguchi Y, Tanizaki K, Nanasato M, Iguchi N, Nitta J, Isobe M. Prognostic predictors and echocardiographic time course after device replacement in patients treated chronically with cardiac resynchronization therapy devices. Heart Vessels 2021; 37:451-459. [PMID: 34499232 DOI: 10.1007/s00380-021-01940-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022]
Abstract
The prognostic predictors of death or heart failure hospitalization and the echocardiographic response after initial cardiac resynchronization therapy (CRT) device replacement (CRT-r) remain unclear. We evaluated the predictors and the echocardiographic time course in patients after CRT-r. Consecutive 60 patients underwent CRT-r because of battery depletion. Patients were divided into two groups depending on the chronic echocardiographic response to CRT (left ventricular end-systolic volume [LVESV] reduction of ≥ 15%) at the time of CRT-r: CRT responders (group A; 35 patients) and CRT nonresponders (group B; 25 patients). The primary endpoint was a composite of death from any cause or heart failure hospitalization. Changes in LVESV and left ventricular ejection fraction (LVEF) after CRT-r were also analyzed. During the mean follow-up of 46 ± 33 months after CRT-r, the primary endpoint occurred more frequently in group B (group A versus group B; 8/35 [23%] patients versus 19/25 [76%] patients, p < 0.001). No significant changes in LVESV and LVEF were observed at the mean of 46 ± 29 months after CRT-r in both groups. A multivariate analysis identified echocardiographic nonresponse to CRT, chronic kidney disease, atrial fibrillation, and New York Heart Association functional class III or IV at the time of CRT-r as independent predictors of the primary endpoint in all patients. Residual echocardiographic nonresponse, comorbidities, and heart failure symptoms at the time of CRT-r predict the subsequent very long-term prognosis after CRT-r. No further echocardiographic response to CRT was found after CRT-r.
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Affiliation(s)
- Takahiko Nagase
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan.
| | - Maya Ishiguro
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Kei Mabuchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Ruiko Seki
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - So Asano
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Hiroshi Fukunaga
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Kohei Tanizaki
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan
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Almusaad A, Sweidan R, Alanazi H, Jamiel A, Bokhari F, Al Hebaishi Y, Al Fagih A, Alrawahi N, Al-Mandalawi A, Hashim M, Al Ghamdi B, Amin M, Elmaghawry M, Al Shoaibi N, Sorgente A, Loricchio M, AlMohani G, Al Abri I, Benjamin E, Sudan N, Chami A, Badie N, Sayed M, Hersi A. Long-term reverse remodeling and clinical improvement by MultiPoint Pacing in a randomized, international, Middle Eastern heart failure study. J Interv Card Electrophysiol 2021; 63:399-407. [PMID: 34156610 PMCID: PMC8983631 DOI: 10.1007/s10840-020-00928-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
Purpose Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing, MPP) has been shown to improve CRT response, although MPP response using automated pacing vector programming has not been demonstrated in the Middle East. The purpose of this study was to compare the impact of MPP to conventional biventricular pacing (BiV) using echocardiographic and clinical changes at 6-month post-implant. Methods This prospective, randomized study was conducted at 13 Middle Eastern centers. After de novo CRT-D implant (Abbott Unify Quadra MP™ or Quadra Assura MP™) with quadripolar LV lead (Abbott Quartet™), patients were randomized to either BiV or MPP therapy. In BiV patients, the LV pacing vector was selected per standard practice; in MPP patients, the two LV pacing vectors were selected automatically using VectSelect. CRT response was defined at 6-month post-implant by a reduction in LV end-systolic volume (ESV) ≥ 15%. Results One hundred and forty-two patients (61 years old, 68% male, NYHA class II/III/IV 19%/75%/6%, 33% ischemic, 57% hypertension, 52% diabetes, 158 ms QRS, 25.8% ejection fraction [EF]) were randomized to either BiV (N = 69) or MPP (N = 73). After 6 months, MPP vs. BiV patients experienced greater ESV reduction (25.0% vs. 15.3%, P = 0.08), greater EF improvement (11.9% vs. 8.6%, P = 0.36), significantly greater ESV response rate (68.5% vs. 50.7%, P = 0.04), and significantly greater NYHA class improvement rate (80.8% vs. 60.3%, P = 0.01). Conclusions With MPP and automatic LV vector selection, more CRT patients in the Middle East experienced reverse remodeling and clinical improvement relative to conventional BiV pacing.
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Affiliation(s)
- Abdulmohsen Almusaad
- King Abdalaziz Medical City -National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
| | - Raed Sweidan
- King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Haitham Alanazi
- King Abdalaziz Medical City -National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Abdelrahman Jamiel
- King Abdalaziz Medical City -National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Fayez Bokhari
- King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | | | - Ahmed Al Fagih
- Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Najib Alrawahi
- National Heart Center at the Royal Hospital, Muscat, Oman
| | | | | | - Bandar Al Ghamdi
- King Faisal Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Naeem Al Shoaibi
- King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | | | | | | | - Ismail Al Abri
- National Heart Center at the Royal Hospital, Muscat, Oman
| | | | | | | | | | - Mohammed Sayed
- Aswan Heart Centre - Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - Ahmad Hersi
- King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
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Ferchaud V, Garcia R, Bidegain N, Degand B, Milliez P, Pezel T, Moubarak G. Non-invasive hemodynamic determination of patient-specific optimal pacing mode in cardiac resynchronization therapy. J Interv Card Electrophysiol 2020; 62:347-356. [PMID: 33128179 DOI: 10.1007/s10840-020-00908-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiac resynchronization therapy (CRT) devices have multiple programmable pacing parameters. The purpose of this study was to determine the best pacing mode, i.e., associated with the greatest acute hemodynamic response, in each patient. METHODS Patients in sinus rhythm and intact atrioventricular conduction were included within 3 months of implantation of devices featuring SyncAV and multipoint pacing (MPP) algorithms. The effect of nominal biventricular pacing using the latest activated electrode (BiV-Late), optimized atrioventricular delay (AVD), nominal and optimized SyncAV, and anatomical MPP was determined by non-invasive measurement of systolic blood pressure (SBP). CRT response was defined as SBP increase > 10% relative to baseline. RESULTS Thirty patients with left bundle branch block (LBBB) were included. BiV-Late increased SBP compared to intrinsic rhythm (128 ± 21 mmHg vs. 121 ± 22 mmHg, p = 0.0002). The best pacing mode further increased SBP to 140 ± 19 mmHg (p < 0.0001 vs. BiV-Late). The proportion of CRT responders increased from 40% with BiV-Late to 80% with the best pacing mode (p = 0.0005). Compared to BiV-Late, optimized AVD and optimized SyncAV increased SBP (to 134 ± 21 mmHg, p = 0.004, and 133 ± 20 mmHg, p = 0.0003, respectively), but nominal SyncAV and MPP did not. The best pacing mode was variable between patients and was different from nominal BiV-Late in 28 (93%) patients. Optimized AVD was the most frequent best mode, in 14 (47%) patients. CONCLUSION In patients with LBBB, the best pacing mode was patient-specific and doubled the magnitude of acute hemodynamic response and the proportion of acute CRT responders compared to nominal BiV-Late pacing. TRIAL REGISTRATION ClinicalTrials.gov : NCT03779802.
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Affiliation(s)
- Virginie Ferchaud
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, 27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France
- Department of Cardiology, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Rodrigue Garcia
- Department of Cardiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Nicolas Bidegain
- Department of Cardiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Bruno Degand
- Department of Cardiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Paul Milliez
- Department of Cardiology, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Théo Pezel
- Department of Cardiology, Centre Hospitalier Universitaire Lariboisière, Paris, France
| | - Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, 27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
- Department of Cardiology, Centre Hospitalier Universitaire Lariboisière, Paris, France.
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Wang Z, Wu Y, Zhang J. Cardiac resynchronization therapy in heart failure patients: tough road but clear future. Heart Fail Rev 2020; 26:735-745. [PMID: 33098491 DOI: 10.1007/s10741-020-10040-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
Cardiac resynchronization therapy (CRT) based on biventricular pacing (BVP) is an invaluable intervention currently used in heart failure (HF) patients. The therapy involves electromechanical dyssynchrony, which can not only improve heart function and quality of life but also reduce hospitalization and mortality rates. However, approximately 30% to 40% of patients remain unresponsive to conventional BVP in clinical practice. In the recent years, extensive research has been employed to find a more physiological approach to cardiac resynchronization. The His-Purkinje system pacing (HPSP) including His bundle pacing (HBP) and left bundle branch area pacing (LBBaP) may potentially be the future of CRT. These technologies present various advantages including offering an almost real physiological pacing, less complicated procedures, and economic feasibility. Additionally, other methods, such as isolated left-ventricular pacing and multipoint pacing, may in the future be important but non-mainstream alternatives to CRT because currently, there is no strong evidence to support their effectiveness. This article reviews the current situation and latest progress in CRT, explores the existing technology, and highlights future prospects in the development of CRT.
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Affiliation(s)
- Ziyu Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Junmeng Zhang
- Department of Cardiology, Heart Center, the First Hospital of Tsinghua University, No. 6 Jiuxianqiao 1st Street, Chaoyang District, Beijing, 100016, China.
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12
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Electrical synchronization achieved by multipoint pacing combined with dynamic atrioventricular delay. J Interv Card Electrophysiol 2020; 61:453-460. [DOI: 10.1007/s10840-020-00842-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
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13
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Zhang C, Liu HX, Deng XQ, Tong L, Wang H, Wang YF, Tong L, Cheng LC, Cai L. Delay optimization of multipoint pacing increases the cardiac index and narrows the QRS width. J Electrocardiol 2020; 60:114-117. [PMID: 32353803 DOI: 10.1016/j.jelectrocard.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The benefits of MPP delay optimization on hemodynamics and ventricular contraction synchronicity can be quantified with cardiac index (CI) and QRS width. A delay with the maximum CI and minimum QRS width may be the optimized settings for multipoint pacing (MPP). METHODS Twelve patients with advanced heart failure who received cardiac resynchronization therapy defibrillation with MPP at the Third People's Hospital of Chengdu from March 2016 to April 2019 were included. Interventricular and intraventricular delays were optimized through noninvasive cardiac output monitoring and a 12 lead ECG. RESULTS According to CI, the optimized left ventricular- left ventricular - right ventricular delay setting was mainly 25 ms-25 ms and 40 ms-40 ms. And the delay with the minimum QRS width was mainly in 5 ms-5 ms, 25 ms-25 ms, and 40 ms-25 ms. The optimal MPP configuration increased CI compared to the MPP setting that produced the minimum CI (4.5 ± 1.3 vs. 2.8 ± 1.0 L/min/m2, P < 0.001). The QRS width of the optimized MPP was narrower than the MPP setting that produced the maximum QRS width (127 ± 20 vs. 160 ± 29 ms, P < 0.001). CONCLUSION Delay optimization improves hemodynamic response and ventricular contraction synchronicity. The delay of 25 ms-25 ms may be the optimal setting for most MPP patients.
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Affiliation(s)
- Cui Zhang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Han-Xiong Liu
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Xiao-Qi Deng
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lin Tong
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Han Wang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Yan-Feng Wang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lan Tong
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lian-Chao Cheng
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China
| | - Lin Cai
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China.
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Forleo GB, Santini L, Calò L, Ricciardi D, Curnis A, Pignalberi C, Calzolari V, Giammaria M, Morani G, Bertaglia E, Ribatti V, Biffi M, Potenza D, Piro A, Covino G, Natale V, Gasperetti A, Notarstefano P, Lavalle C, Nabutovsky Y, Tondo C, Zanon F. Clinical and economic impact of multipoint left ventricular pacing: A comparative analysis from the Italian registry on multipoint pacing in cardiac resynchronization therapy (IRON‐MPP). J Cardiovasc Electrophysiol 2020; 31:1166-1174. [DOI: 10.1111/jce.14433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni B. Forleo
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco” Milano Italy
| | - Luca Santini
- Division of CardiologyOspedale GB Grassi Ostia Italy
| | - Leonardo Calò
- Division of CardiologyPoliclinico Casilino Roma Italy
| | - Danilo Ricciardi
- Department of CardiologyPoliclinico Universitario Campus Bio‐Medico Italy
| | - Antonio Curnis
- Department of CardiologySpedali Civili di Brescia Brescia Italy
| | | | | | | | - Giovanni Morani
- Department of CardiologyAzienda Ospedaliera Universitaria Verona Italy
| | | | | | - Mauro Biffi
- Department of CardiologyPoliclinico S. Orsola‐Maplighi Bologna Italy
| | - Domenico Potenza
- Division of CardiologyOspedale Casa Sollievo Della Sofferenza San Giovanni Rotondo Italy
| | - Agostino Piro
- Department of CardiologyPoliclinico Universitario Umberto I Roma Italy
| | - Gregorio Covino
- Division of CardiologyOspedale San Giovanni Bosco Napoli Italy
| | - Veronica Natale
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco” Milano Italy
| | - Alessio Gasperetti
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco” Milano Italy
- Department of CardiologyCentro Cardiologico Monzino Milano Italy
| | | | - Carlo Lavalle
- Department of CardiologyPoliclinico Universitario Umberto I Roma Italy
| | | | - Claudio Tondo
- Department of CardiologyCentro Cardiologico Monzino Milano Italy
| | - Francesco Zanon
- Division of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
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15
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García Guerrero JJ, Fernández de la Concha Castañeda J, Chacón Piñero A, Hidalgo Martínez C, Badie N, McSpadden L, Ryu K. Extending multipoint pacing CRT battery longevity by swapping left ventricular pulse configurations. J Interv Card Electrophysiol 2020; 57:481-487. [DOI: 10.1007/s10840-020-00720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/23/2020] [Indexed: 11/29/2022]
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16
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Forleo GB, Gasperetti A, Ricciardi D, Curnis A, Bertaglia E, Calò L, Pignalberi C, Calzolari V, Ribatti V, Lavalle C, Potenza D, Tondi L, Natale V, Notarstefano P, Viecca M, Morani G, Biffi M, Giammaria M, Zanon F, Santini L. Impact of multipoint pacing on projected battery longevity in cardiac resynchronization therapy. An IRON‐MPP study sub‐analysis. J Cardiovasc Electrophysiol 2019; 30:2885-2891. [DOI: 10.1111/jce.14254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/11/2019] [Accepted: 10/25/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Giovanni B. Forleo
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco”Milano Italy
| | - Alessio Gasperetti
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco”Milano Italy
| | - Danilo Ricciardi
- Department of CardiologyPoliclinico Universitario Campus Bio‐Medico Italy
| | - Antonio Curnis
- Department of CardiologyOspedali Civili di BresciaBrescia Italy
| | | | - Leonardo Calò
- Department of CardiologyPoliclinico CasilinoRoma Italy
| | | | | | | | - Carlo Lavalle
- Department of CardiologyPoliclinico Universitario Umberto IRoma Italy
| | - Domenico Potenza
- Department of CardiologyOspedale Casa Sollievo Della Sofferenza S.Giovanni Rotondo Italy
| | - Lara Tondi
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco”Milano Italy
| | - Veronica Natale
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco”Milano Italy
| | | | - Maurizio Viecca
- Department of CardiologyAzienda Ospedaliera‐Universitaria “Luigi Sacco”Milano Italy
| | - Giovanni Morani
- Department of CardiologyAzienda Ospedaliera Universitaria VeronaVerona Italy
| | - Mauro Biffi
- Department of CardiologyPoliclinico S. Orsola‐MaplighiBologna Italy
| | | | - Francesco Zanon
- Department of CardiologySanta Maria della Misericordia HospitalRovigo Italy
| | - Luca Santini
- Department of CardiologyOspedale GB Grassi Ostia Italy
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17
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Clinical outcome of left ventricular multipoint pacing versus conventional biventricular pacing in cardiac resynchronization therapy: a systematic review and meta-analysis. Heart Fail Rev 2019; 23:927-934. [PMID: 30209643 DOI: 10.1007/s10741-018-9737-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with systolic heart failure. Unlike conventional biventricular pacing (BIP), the left ventricular multipoint pacing (MPP) can increase the number of left ventricular pacing sites via a quadripolar lead positioned in the coronary sinus. This synthetic study was conducted to integratively and quantitatively evaluate the clinical outcome of MPP in comparison with BIP. We systematically searched the databases of EMBASE, Ovid medline, and Cochrane Library through May 2018 for studies comparing the clinical outcome of MPP with BIP in the patients who accepted CRT. Hospitalization for reason of heart failure, left ventricular eject fraction (LVEF), CRT response, all-cause morbidity, and cardiovascular death rate was collected for meta-analysis. A total of 11 studies with 29,606 participants were included in this meta-analysis. Compared with BIP group, MPP decreased heart failure hospitalization (OR, 0.41; 95% CI, 0.33 to 0.50; P < 0.00001), improved LVEF (mean difference, 4.97; 95% CI, 3.11 to 6.83; P < 0.00001), increased CRT response (OR, 3.64; 95% CI, 1.68 to 7.87; P = 0.001), and decreased all-cause morbidity (OR, 0.41; 95% CI, 0.26-0.66; P = 0.0002) and cardiovascular death rate (OR, 0.21; 95% CI, 0.11-0.40; P < 0.00001). The published literature demonstrates that MPP was more effective than BIP in the heart failure patients who accepted cardiac resynchronization therapy.
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18
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Multisite pacing via a quadripolar lead for cardiac resynchronization therapy. J Interv Card Electrophysiol 2019; 56:117-125. [PMID: 31321658 DOI: 10.1007/s10840-019-00592-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Cardiac resynchronization therapy is challenging. Up to 40% of patients are non-responder. Multisite pacing via a quadripolar lead, also called multipoint/multipole pacing (MPP), is a debated alternative. In this review, we summarize evidence in the literature, tips and pitfalls related to MPP programming, and the different algorithms of MPP in different manufacturers.
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19
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Zhu M, Chen H, Fulati Z, Liu Y, Su Y, Shu X. Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:356-365. [PMID: 30632611 DOI: 10.1002/jcu.22687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/19/2018] [Accepted: 12/25/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the acute effect of multipoint pacing (MPP) and search for the better baseline predictors of response to MPP for guiding patient selection. METHODS We enrolled 46 heart failure patients scheduled for implantation of MPP-enabled cardiac resynchronization therapy (CRT) devices. An acute pacing protocol including conventional CRT and MPP pacing configurations was performed after implantation. Echocardiography was used at baseline and during pacing test, and response was defined as left ventricular (LV) end-systolic volume (ESV) reduction ≥ 15% at 6-month follow-up. RESULTS MPP response was present in 32 (69%) patients. Responders showed significantly superior LV ejection fraction, global longitudinal peak strain (GLPS), and mechanical dispersion (MD) with MPP than with conventional CRT (all P < 0.05). Baseline GLPS (OR 1.524; 95% CI 1.031-2.251; P = 0.034) and MD (OR 1.048; 95% CI 1.016-1.081; P = 0.003) were independent predictors of MPP response in multivariate regression analysis. Both |GLPS| and MD were significantly correlated with percentage change in LVESV (▵LVESV%) at 6-month follow-up (r = 0.731 and r = 0.696, respectively; all P < 0.001). |GLPS| ≥ 5.0% combined with MD ≥ 120 ms predicted MPP response with the optimal sensitivity of 91% and specificity of 71% (AUC = 0.848, P < 0.001). CONCLUSIONS MPP tends to be superior to conventional CRT in improving acute response. |GLPS| and MD can successfully predict response to MPP, and their combination can further improve the prediction accuracy of response.
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Affiliation(s)
- Mengruo Zhu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zibire Fulati
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yang Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai, China
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20
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Leclercq C, Burri H, Curnis A, Delnoy PP, Rinaldi CA, Sperzel J, Lee K, Calò L, Vicentini A, Concha JF, Thibault B. Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing (MORE-CRT MPP) study: results from Phase I. Eur Heart J 2019; 40:2979-2987. [DOI: 10.1093/eurheartj/ehz109] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/26/2018] [Accepted: 02/16/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
To assess the impact of MultiPoint™ Pacing (MPP)—programmed according to the physician’s discretion—in non-responders to standard biventricular pacing after 6 months.
Methods and results
The study enrolled 1921 patients receiving a quadripolar cardiac resynchronization therapy (CRT) system capable of MPP™ therapy. A core laboratory assessed echocardiography at baseline and 6 months and defined volumetric non-response to biventricular pacing as <15% reduction in left ventricular end-systolic volume (LVESV). Clinical sites randomized patients classified as non-responders in a 1:1 ratio to receive MPP (236 patients) or continued biventricular pacing (231 patients) for an additional 6 months and evaluated rate of conversion to echocardiographic response. Baseline characteristics of both groups were comparable. No difference was observed in non-responder to responder conversion rate between MPP and biventricular pacing (31.8% and 33.8%, P = 0.72). In the MPP arm, 68 (29%) patients received MPP programmed with a wide LV electrode anatomical separation (≥30 mm) and shortest LV1–LV2 and LV2–RV timing delays (MPP-AS); 168 (71%) patients received MPP programmed with other settings (MPP-Other). MPP-AS elicited a significantly higher non-responder conversion rate compared to MPP-Other (45.6% vs. 26.2%, P = 0.006) and a trend in a higher conversion rate compared to biventricular pacing (45.6% vs. 33.8%, P = 0.10).
Conclusions
After 6 months, investigator-discretionary MPP programming did not significantly increase echocardiographic response compared to biventricular pacing in CRT non-responders.
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21
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Rationale and design of a randomized clinical trial to assess the safety and efficacy of multipoint pacing therapy: MOre REsponse on Cardiac Resynchronization Therapy with MultiPoint Pacing (MORE-CRT MPP-PHASE II). Am Heart J 2019; 209:1-8. [PMID: 30616009 DOI: 10.1016/j.ahj.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. Data from the MultiPoint Pacing (MPP) IDE trial and MORE-CRT MPP-PHASE I study suggest improved response in subjects in the MPP arm-programmed with wide left ventricular (LV) electrode anatomical separation (≥30 mm) and shortest timing delays of 5 milliseconds (MPP-AS)-compared with quadripolar biventricular (BiV) pacing. STUDY DESIGN The MORE-CRT MPP-PHASE II trial is a prospective, randomized, multicenter study to assess the 6-month impact of MPP programmed to mandated MPP-AS settings in subjects who do not respond to 6 months of BiV pacing (MPP OFF). Approximately 5,000 subjects with a standard CRT indication will be enrolled and implanted with a quadripolar CRT system (Abbott) capable of delivering MPP. Only BiV pacing is activated at implant. At 6 months, subjects classified as CRT nonresponders (<15% reduction in LV end-systolic volume) are randomized (1:1) to MPP or continued BiV pacing. The mandated MPP parameters (eg, MPP-AS) are programmed to subjects randomized to the MPP arm. At 12 months, the 2 groups will be compared to determine if there is a difference in CRT response rate. CONCLUSIONS This trial will evaluate whether MPP programmed to mandated MPP-AS settings improves LV reverse remodeling and clinical response to CRT in patients who fail to respond to 6 months of BiV pacing (www.clinicaltrials.gov identifier NCT02006069).
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22
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Thibault B, Mondésert B, Cadrin-Tourigny J, Dubuc M, Macle L, Khairy P. Benefits of Multisite/Multipoint Pacing to Improve Cardiac Resynchronization Therapy Response. Card Electrophysiol Clin 2019; 11:99-114. [PMID: 30717857 DOI: 10.1016/j.ccep.2018.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article provides a general overview of the underlying mechanisms that support pacing from more discrete points and/or a wider vector (multisite and multipoint pacing) to improve left ventricular resynchronization. We performed a critical overview of the current literature and to identify some remaining knowledge gaps to spur further research. It was not our goal to provide a systematic review with a comprehensive bibliography, but rather to focus on selected publications that, in our opinion, have either expertly reviewed a specific aspect of cardiac resynchronization therapy or have been landmark studies in the field.
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Affiliation(s)
- Bernard Thibault
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada.
| | - Blandine Mondésert
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Julia Cadrin-Tourigny
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Marc Dubuc
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Laurent Macle
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Paul Khairy
- Department of Cardiology, Montréal Heart Institute, University of Montréal, 5000 Bélanger Street, Montréal, Québec, H1T 1C8, Canada
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Ciconte G, Ćalović Ž, McSpadden LC, Ryu K, Mangual J, Caporaso I, Baldi M, Saviano M, Cuko A, Vitale R, Conti M, Giannelli L, Vicedomini G, Santinelli V, Pappone C. Multipoint left ventricular pacing improves response to cardiac resynchronization therapy with and without pressure-volume loop optimization: comparison of the long-term efficacy of two different programming strategies. J Interv Card Electrophysiol 2018; 54:141-149. [DOI: 10.1007/s10840-018-0480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
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Müller-Leisse J, Zormpas C, König T, Duncker D, Veltmann C. [Multipoint pacing-more CRT or a waste of battery power?]. Herz 2018; 43:596-604. [PMID: 30209518 DOI: 10.1007/s00059-018-4751-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with broad QRS complex ≥130 ms and heart failure with reduced ejection fraction despite optimal guideline-directed medical therapy. However, approximately 30% of the patients implanted with a CRT system do not show clinical benefit. Reasons for nonresponse are complex and some aspects can be addressed during follow-up. Based on quadripolar lead technology, multipoint pacing (MPP) allows left ventricular stimulation at two different sites along the lead. In particular, in scarred and fibrotic ventricular myocardium stimulation at two different sites may overcome conduction barriers and lead to homogeneous ventricular depolarization. Especially for patients that do not respond to conventional CRT, activation of MPP may present an option to increase clinical response. On the other hand, MPP may significantly decrease battery longevity.This review offers an overview of the current knowledge and data on MPP balancing the potential clinical benefit and the possible disadvantages of this therapy.
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Affiliation(s)
- J Müller-Leisse
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Zormpas
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - T König
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - D Duncker
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Veltmann
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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25
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Lercher P, Lunati M, Rordorf R, Landolina M, Badie N, Qu F, Casset C, Ryu K, Ghio S, Singh JP, Leclercq C. Long-term reverse remodeling by cardiac resynchronization therapy with MultiPoint Pacing: A feasibility study of noninvasive hemodynamics-guided device programming. Heart Rhythm 2018; 15:1766-1774. [PMID: 29940305 DOI: 10.1016/j.hrthm.2018.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint Pacing [MPP]) improves acute hemodynamics and chronic outcomes in comparison to conventional biventricular pacing (BiV), though MPP programming questions persist. OBJECTIVES In this multicenter feasibility study, we evaluated the feasibility of using noninvasive systolic blood pressure (SBP) to guide MPP programming and assessed the chronic 6-month echocardiographic CRT response. METHODS Patients implanted with MPP-enabled CRT-defibrillator devices underwent noninvasive hemodynamic assessment (finger arterial pressure) during a pacing protocol that included atrial-only pacing and various BiV and MPP configurations. Each configuration was repeated 4 times, alternating with a reference pacing configuration, to calculate the SBP difference relative to reference (ΔSBP). CRT configurations with the greatest ΔSBP were programmed. An independent core laboratory analyzed baseline and 6-month echocardiograms, with CRT response defined as a 6-month reduction in LV end-systolic volume ≥ 15%. RESULTS Forty-two patients (71% male; LV ejection fraction 30.3% ± 7.5%; QRS duration 161 ± 19 ms; 26% had ischemic cardiomyopathy) were enrolled in 4 European centers. Relative to atrial-only pacing, the best BiV and best MPP configurations produced significant SBP elevations of 3.1 ± 4.2 (P < .01) and 4.1 ± 4.1 mm Hg (P < .01), respectively (BiV vs MPP; P < .01). Greater SBP elevations were associated with the best MPP compared with the best BiV configurations in 29 of 37 patients completing the pacing protocol (78%). Of MPP-programmed patients completing the 6-month follow-up visit, 23 of 27 (85%) were classified as CRT responders (6-month reduction in LV end-systolic volume 37.0% ± 13.6%). CONCLUSION Acute noninvasive hemodynamics after CRT device implantation predominantly favored MPP over BiV programming. MPP programming guided by noninvasive hemodynamics resulted in positive LV structural remodeling.
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Affiliation(s)
- Peter Lercher
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Maurizio Lunati
- Cardiac Department, Niguarda Ca' Granda, Granda Hospital, Milan, Italy
| | | | - Maurizio Landolina
- Cardiac Department, Policlinico San Matteo, Pavia, Italy; Cardiology Department, Ospedale Maggiore di Crema, Crema, Italy
| | | | | | | | | | - Stefano Ghio
- Cardiac Department, Policlinico San Matteo, Pavia, Italy
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Siciliano M, Migliore F, Badano L, Bertaglia E, Pedrizzetti G, Cavedon S, Zorzi A, Corrado D, Iliceto S, Muraru D. Cardiac resynchronization therapy by multipoint pacing improves response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo study. Europace 2018; 19:1833-1840. [PMID: 28025231 DOI: 10.1093/europace/euw331] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023] Open
Abstract
Aims To characterize the effect of multipoint pacing (MPP) compared to biventricular pacing (BiV) on left ventricle (LV) mechanics and intraventricular fluid dynamics by three-dimensional echocardiography (3DE) and echocardiographic particle imaging velocimetry (Echo-PIV). Methods and results In 11 consecutive patients [8 men; median age 65 years (57-75)] receiving cardiac resynchronization therapy (CRT) with a quadripolar LV lead (Quartet,St.Jude Medical,Inc.), 3DE and Echo-PIV data were collected for each pacing configuration (CRT-OFF, BiV, and MPP) at follow-up after 6 months. 3DE data included LV volumes, LV ejection fraction (LVEF), strain, and systolic dyssynchrony index (SDI). Echo-PIV was used to evaluate the directional distribution of global blood flow momentum, ranging from zero, when flow force is predominantly along the base-apex direction, up to 90° when it becomes transversal. MPP resulted in significant reduction in end-diastolic and end-systolic volumes compared with both CRT-OFF (P = 0.02; P = 0.008, respectively) and BiV (P = 0.04; P = 0.03, respectively). LVEF and cardiac output were significant superior in MPP compared with CRT-OFF, but similar between MPP and BiV. Statistical significant differences when comparing global longitudinal and circumferential strain and SDI with MPP vs. CRT-OFF were observed (P = 0.008; P = 0.008; P = 0.01, respectively). There was also a trend towards improvement in strain between BiV and MPP that did not reach statistical significance. MPP reflected into a significant reduction of the deviation of global blood flow momentum compared with both CRT-OFF and BiV (P = 0.002) indicating a systematic increase of longitudinal alignment from the base-apex orientation of the haemodynamic forces. Conclusion These preliminary results suggest that MPP resulted in significant improvement of LV mechanics and fluid dynamics compared with BiV. However, larger studies are needed to confirm this hypothesis.
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Affiliation(s)
- Mariachiara Siciliano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Luigi Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, P. Europa 1, 34127 Trieste, Italy
| | - Stefano Cavedon
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
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Forleo GB, Santini L, Giammaria M, Potenza D, Curnis A, Calabrese V, Ricciardi D, D'agostino C, Notarstefano P, Ribatti V, Morani G, Mantica M, Di Biase L, Bertaglia E, Calò L, Zanon F. Multipoint pacing via a quadripolar left-ventricular lead: preliminary results from the Italian registry on multipoint left-ventricular pacing in cardiac resynchronization therapy (IRON-MPP). Europace 2018; 19:1170-1177. [PMID: 27189954 PMCID: PMC5834139 DOI: 10.1093/europace/euw094] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/12/2016] [Indexed: 12/02/2022] Open
Abstract
Aims This registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices. Methods and results A total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to ‘ON’ in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to ‘ON’ (n = 94) or ‘OFF’ (n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly (P < 0.001). Conclusion This study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF. Clinical Trial Registration http://www.clinicaltrial.gov/. Unique identifier: NCT02606071.
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Affiliation(s)
- Giovanni B Forleo
- Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Luca Santini
- Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | | | - Domenico Potenza
- Ospedale Casa Sollievo Della Sofferenza, S.Giovanni Rotondo, Italy
| | | | - Vito Calabrese
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | | | | | - Valentina Ribatti
- Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
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Zanon F, Marcantoni L, Baracca E, Pastore G, Giau G, Rigatelli G, Lanza D, Picariello C, Aggio S, Giatti S, Zuin M, Roncon L, Pacetta D, Noventa F, Prinzen FW. Hemodynamic comparison of different multisites and multipoint pacing strategies in cardiac resynchronization therapies. J Interv Card Electrophysiol 2018; 53:31-39. [PMID: 29627954 PMCID: PMC6153901 DOI: 10.1007/s10840-018-0362-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/22/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE In order to increase the responder rate to CRT, stimulation of the left ventricular (LV) from multiple sites has been suggested as a promising alternative to standard biventricular pacing (BIV). The aim of the study was to compare, in a group of candidates for CRT, the effects of different pacing configurations-BIV, triple ventricular (TRIV) by means of two LV leads, multipoint (MPP), and multipoint plus a second LV lead (MPP + TRIV) pacing-on both hemodynamics and QRS duration. METHODS Fifteen patients (13 male) with permanent AF (mean age 76 ± 7 years; left ventricular ejection fraction 33 ± 7%; 7 with ischemic cardiomyopathy; mean QRS duration 178 ± 25 ms) were selected as candidates for CRT. Two LV leads were positioned in two different branches of the coronary sinus. Acute hemodynamic response was evaluated by means of a RADI pressure wire as the variation in LVdp/dtmax. RESULTS Per patient, 2.7 ± 0.7 veins and 5.2 ± 1.9 pacing sites were evaluated. From baseline values of 998 ± 186 mmHg/s, BIV, TRIV, MPP, and MPP-TRIV pacing increased LVdp/dtmax to 1200 ± 281 mmHg/s, 1226 ± 284 mmHg/s, 1274 ± 303 mmHg, and 1289 ± 298 mmHg, respectively (p < 0.001). Bonferroni post-hoc analysis showed significantly higher values during all pacing configurations in comparison with the baseline; moreover, higher values were recorded during MPP and MPP + TRIV than at the baseline or during BIV and also during MPP + TRIV than during TRIV. Mean QRS width decreased from 178 ± 25 ms at the baseline to 171 ± 21, 167 ± 20, 168 ± 20, and 164 ± 15 ms, during BIV, TRIV, MPP, and MPP-TRIV, respectively (p < 0.001). CONCLUSIONS In patients with AF, the acute response to CRT improves as the size of the early activated LV region increases.
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Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia General Hospital, Rovigo, Italy. .,Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy.
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia General Hospital, Rovigo, Italy.,Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Enrico Baracca
- Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia General Hospital, Rovigo, Italy.,Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia General Hospital, Rovigo, Italy.,Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Giuseppina Giau
- Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia General Hospital, Rovigo, Italy.,Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Gianluca Rigatelli
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy.,Interventional Cardiology Unit, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | - Daniela Lanza
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Claudio Picariello
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Silvio Aggio
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Sara Giatti
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Marco Zuin
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | - Loris Roncon
- Cardiology Department, Santa Maria Della Misericordia General Hospital, 140, Viale Tre Martiri, 45100, Rovigo, Italy
| | | | - Franco Noventa
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Cano Pérez Ó, Pombo Jiménez M, Fidalgo Andrés ML, Lorente Carreño D, Coma Samartín R. Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:1083-1097. [PMID: 28965962 DOI: 10.1016/j.rec.2017.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES This report describes the results of analysis of implanted pacemakers reported to the Spanish Pacemaker Registry. METHODS The analysis was based on information provided by the European Pacemaker Identification Card. RESULTS Information was received from 115 hospitals, with a total of 12 697 cards, representing 32.3% of the estimated activity. Use of conventional and resynchronization pacemakers was 818 and 79 units per million inhabitants, respectively. A total of 200 leadless pacemakers were implanted. The mean age of the patients receiving an implant was 77.8 years, and 52% of devices were implanted in persons older than 80 years. In all, 74.9% were first implants and 23.4% corresponded to generator exchange. Endocardial leads were bipolar, 82.9% with active fixation, and 16.1% had magnetic resonance imaging protection. Most patients received bicameral sequential pacing, although single chamber pacing VVI(R) was used in 26.7% of the patients with sick sinus syndrome and in 23.8% of those with atrioventricular block, despite sinus rhythm. CONCLUSIONS Total use of pacemaker generators in Spain has increased by 1.6% compared with 2015. Most implanted leads have active fixation and less than 20% have magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could be improved in around 32% of patients.
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Affiliation(s)
- Óscar Cano Pérez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - Marta Pombo Jiménez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación, Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - María Luisa Fidalgo Andrés
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitario de León, León, Spain
| | - Diego Lorente Carreño
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital San Pedro, Logroño, La Rioja, Spain
| | - Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Cuidados Críticos Cardiológicos, Hospital 12 de Octubre, Madrid, Spain
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Cano Pérez Ó, Pombo Jiménez M, Fidalgo Andrés ML, Lorente Carreño D, Coma Samartín R. Registro Español de Marcapasos. XIV Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2016). Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Akerström F, Narváez I, Puchol A, Pachón M, Martín-Sierra C, Rodríguez-Mañero M, Rodríguez-Padial L, Arias MA. Estimation of the effects of multipoint pacing on battery longevity in routine clinical practice. Europace 2017; 20:1161-1167. [DOI: 10.1093/europace/eux209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/25/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Finn Akerström
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
| | - Irene Narváez
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
| | - Alberto Puchol
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
| | - Marta Pachón
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
| | - Cristina Martín-Sierra
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
| | - Moisés Rodríguez-Mañero
- Arrhytmia Unit, Cardiology Service, University Hospital Santiago, Travesía de Choupana s/n, Santiago de Compostela, Spain
| | - Luis Rodríguez-Padial
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
| | - Miguel A Arias
- Department of Cardiology, Cardiac Arrhythmia and Electrophysiology Unit, Hospital Virgen de la Salud, Avda Barber 30, Toledo, Spain
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Hipólito Reis A. Universal response to cardiac resynchronization therapy: A challenge still to be overcome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Reis AH. Resposta universal à terapêutica de ressincronização cardíaca – um desafio por resolver. Rev Port Cardiol 2017; 36:427-430. [DOI: 10.1016/j.repc.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Qiu Q, Yang L, Mai JT, Yang Y, Xie Y, Chen YX, Wang JF. Acute Effects of Multisite Biventricular Pacing on Dyssynchrony and Hemodynamics in Canines With Heart Failure. J Card Fail 2017; 23:304-311. [DOI: 10.1016/j.cardfail.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023]
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Tayal B, Sogaard P, Delgado-Montero A, Goda A, Saba S, Risum N, Gorcsan J. Interaction of Left Ventricular Remodeling and Regional Dyssynchrony on Long-Term Prognosis after Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2017; 30:244-250. [DOI: 10.1016/j.echo.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 10/20/2022]
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Cano Pérez O, Pombo Jiménez M, Lorente Carreño D, Fidalgo Andrés ML. Selección de lo mejor del año 2016 en terapia de resincronización cardiaca. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cano Pérez O, Pombo Jiménez M, Lorente Carreño D, Fidalgo Andrés ML. Selection of the Best of 2016 on Cardiac Pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:64-65. [PMID: 27914871 DOI: 10.1016/j.rec.2016.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/28/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Oscar Cano Pérez
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - Marta Pombo Jiménez
- Unidad de Estimulación Cardiaca, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | | - Maria Luisa Fidalgo Andrés
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Complejo Hospitalario de León, León, Spain
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Pombo Jiménez M, Cano Pérez Ó, Fidalgo Andrés ML, Lorente Carreño D, Coma Samartín R. Registro Español de Marcapasos. XIII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2015). Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.08.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pombo Jiménez M, Cano Pérez Ó, Fidalgo Andrés ML, Lorente Carreño D, Coma Samartín R. Spanish Pacemaker Registry. Thirteenth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2015). ACTA ACUST UNITED AC 2016; 69:1190-1203. [PMID: 27825715 DOI: 10.1016/j.rec.2016.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES We describe the results of the analysis of the devices implanted and conveyed to the Spanish Pacemaker Registry in 2015. METHODS The report is based on the processing of information provided by the European Pacemaker Patient Identification Card. RESULTS We received information from 111 hospitals, with a total of 12 555 cards, representing 32.1% of all the estimated activity. The use of conventional generators and resynchronization devices was 820 and 73 units per million population, respectively. The mean age of the patients receiving an implantation was 77.7 years, and more than 50% of the devices were implanted in patients over 80 years of age. Overall, 58.6% of the implants and 58.8% of the replacements were performed in men. All of the endocardial leads employed were bipolar, 81.5% had an active fixation system, and 16.5% were compatible with magnetic resonance. Although dual chamber sequential pacing continues to be more widespread, pacing with VVI/R mode is used because up to 23.8% of the patients with sinus node disease are in sinus rhythm, as are 24.1% of those with atrioventricular block. CONCLUSIONS The total use of pacemaker generators in Spain has increased by about 5% with respect to 2014. The majority of the leads implanted are of active fixation, and less than 20% are protected from magnetic resonance. The factors directly related to the selection of pacing mode are age and sex. In around 20% of patients, the choice of the pacing mode could be improved.
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Affiliation(s)
- Marta Pombo Jiménez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación, Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain.
| | - Óscar Cano Pérez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Luisa Fidalgo Andrés
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitario de León, León, Spain
| | - Diego Lorente Carreño
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital San Pedro, Logroño, La Rioja, Spain
| | - Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Cuidados Críticos Cardiológicos, Hospital 12 de Octubre, Madrid, Spain
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Zanon F, Marcantoni L, Baracca E, Pastore G, Lanza D, Fraccaro C, Picariello C, Conte L, Aggio S, Roncon L, Pacetta D, Badie N, Noventa F, Prinzen FW. Optimization of left ventricular pacing site plus multipoint pacing improves remodeling and clinical response to cardiac resynchronization therapy at 1 year. Heart Rhythm 2016; 13:1644-51. [DOI: 10.1016/j.hrthm.2016.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 11/29/2022]
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