Multipoint Left Ventricular Pacing in a Single Coronary Sinus Branch Improves Mid‐Term Echocardiographic and Clinical Response to Cardiac Resynchronization Therapy

医学 心脏再同步化治疗 心脏病学 内科学 冠状窦 心力衰竭 QRS波群 植入 窦性心律 射血分数 外科 心房颤动
作者
Carlo Pappone,Žarko Ćalović,Gabriele Vicedomini,Amarild Cuko,Luke C. McSpadden,Kyungmoo Ryu,Enrico Romano,Mario Baldi,Massimo Saviano,Alessia Pappone,Cristiano Ciaccio,Luigi Giannelli,Bogdan Ionescu,Andrea Petretta,Raffaele Vitale,Angelica Fundaliotis,Luigi Tavazzi,Vincenzo Santinelli
出处
期刊:Journal of Cardiovascular Electrophysiology [Wiley]
卷期号:26 (1): 58-63 被引量:56
标识
DOI:10.1111/jce.12513
摘要

Multipoint LV Pacing Improves Mid‐Term CRT Response Introduction Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing in a single coronary sinus branch improves acute LV function. We hypothesized that multipoint pacing (MPP) can improve midterm echocardiographic and clinical response compared with conventional CRT. Methods and Results Consecutive patients receiving a CRT implant (Unify Quadra MP™ or Quadra Assura MP™ CRT‐D and Quartet™ LV lead, St. Jude Medical, Sylmar, CA, USA) were randomized to receive biventricular (BiV) pacing with either conventional LV pacing (CONV group) or MPP (MPP group). For each patient, an optimal pacing configuration for the assigned pacing mode was programmed based on intraoperative pressure‐volume (PV) loop measurements. A clinical evaluation and transthoracic echocardiogram were performed before implant (BASELINE) and at 3 months postimplant and analyzed by a blinded observer. A reduction in end‐systolic volume (ESV) of ≥15% relative to BASELINE was prospectively defined as response to CRT. Forty‐four patients (NYHA Class III, EF 29 ± 6%, QRS duration 152 ± 17 milliseconds) were enrolled and randomized. One patient in the MPP group was lost to follow‐up and excluded from further analysis. After 3 months, 11 of 22 (50%) CONV patients and 16 of 21 (76%) MPP patients were classified as responders. ESV reduction, EF increase, and NYHA class reduction relative to BASELINE were significantly greater in the MPP group than in the CONV group (ESV: −21.0 ± 13.9 vs. −12.6 ± 11.1%, P = 0.03; EF: +9.8 ± 5.1 vs. +2.0 ± 7.8 percentage points, P < 0.001; ΔNYHA: −1.05 ± 0.22 vs. −0.72 ± 0.46 functional classes, P = 0.006). Conclusion PV loop optimized BiV pacing with MPP resulted in an improved rate of response to CRT.
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