1
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Leclercq C, Burri H, Delnoy PP, Rinaldi CA, Sperzel J, Calò L, Concha JF, Fusco A, Al Samadi F, Lee K, Thibault B. Cardiac resynchronization therapy non-responder to responder conversion rate in the MORE-CRT MPP trial. Europace 2023; 25:euad294. [PMID: 37776313 PMCID: PMC10561537 DOI: 10.1093/europace/euad294] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 10/02/2023] Open
Abstract
AIMS To assess the impact of MultiPoint™ Pacing (MPP) in cardiac resynchronization therapy (CRT) non-responders after 6 months of standard biventricular pacing (BiVP). METHODS AND RESULTS The trial enrolled 5850 patients who planned to receive a CRT device. The echocardiography core laboratory assessed CRT response before implant and after 6 months of BiVP; non-response to BiVP was defined as <15% relative reduction in left ventricular end-systolic volume (LVESV). Echocardiographic non-responders were randomized in a 1:1 ratio to receive MPP (541 patients) or continued BiVP (570 patients) for an additional 6 months and evaluated the conversion rate to the echocardiographic response. The characteristics of both groups at randomization were comparable. The percentage of non-responder patients who became responders to CRT therapy was 29.4% in the MPP arm and 30.4% in the BIVP arm (P = 0.743). In patients with ≥30 mm spacing between the two left ventricular pacing sites (MPP-AS), identified during the first phase as a potential beneficial subgroup, no significant difference in the conversion rate was observed. CONCLUSION Our trial shows that ∼30% of patients, who do not respond to CRT in the first 6 months, experience significant reverse remodelling in the following 6 months. This finding suggests that CRT benefit may be delayed or slowly incremental in a relevant proportion of patients and that the percentage of CRT responders may be higher than what has been described in short-/middle-term studies. MultiPoint™ Pacing does not improve CRT response in non-responders to BiVP, even with MPP-AS.
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Affiliation(s)
- Christophe Leclercq
- Service de Cardiologie et Maladies Vasculaires, Université de Rennes I, CICIT 804, CHU Pontchaillou Rennes, 2, rue Henri le Guilloux 35033 Rennes Cédex 09, Rennes 35033, France
| | - Haran Burri
- Departement of Cardiology, University of Geneva, Geneva, Switzerland
| | - Peter Paul Delnoy
- Isala Hospital, Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands
| | | | - Johannes Sperzel
- The Kerckhoff Heart and Thorax Center, Bad Nauheim, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | | | | | | | | | - Bernard Thibault
- Electrophysiology Service Department of Cardiology, Université de Montréal, Montreal, Canada
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2
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Green PG, Herring N, Betts TR. What Have We Learned in the Last 20 Years About CRT Non-Responders? Card Electrophysiol Clin 2022; 14:283-296. [PMID: 35715086 DOI: 10.1016/j.ccep.2021.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although cardiac resynchronization therapy (CRT) has become well established in the treatment of heart failure, the management of patients who do not respond after CRT remains a key challenge. This review will summarize what we have learned about non-responders over the last 20 years and discuss methods for optimizing response, including the introduction of novel therapies.
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Affiliation(s)
- Peregrine G Green
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK; Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Oxford, OX3 9DU, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Timothy R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK; Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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3
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Abstract
Left ventricular (LV) dP/dtmax provides a sensitive measure of the acute hemodynamic response to cardiac resynchronization therapy (CRT) and can predict reverse remodeling on echocardiography. Its use to guide LV lead placement has been shown to improve outcomes in a multicenter randomized trial. Given the invasive protocol required for measurement, it is unlikely to be universally beneficial for patients undergoing CRT but may be useful for patients who do not respond to conventional CRT, or in those who have borderline indications or risk factors for non-response. In such cases, LV dP/dtmax may help guide LV lead placement, optimize device programming, and select the best alternative method of delivering CRT, such endocardial LV pacing or conduction system pacing.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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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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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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6
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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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7
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Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters. Heart Rhythm O2 2021; 2:682-690. [PMID: 34988517 PMCID: PMC8710588 DOI: 10.1016/j.hroo.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) therapy, as it has reduced mortality and morbidity and has shown improvement in functional capacity. Multipoint pacing (MPP) is a way of configuring CRT with the aim to improve the percentage of patients who respond to CRT. Objective To demonstrate the effectiveness of the MPP compared to traditional biventricular pacing (BiV). Methods We performed a systematic review and meta-analysis according to PRISMA guidelines of studies in which MPP vs BiV strategy were compared. Results MPP use is associated with a higher rate of patients experiencing functional improvement (odds ratio: 2.51, 95% confidence interval [CI], 1.56–4.06; P = .0002) and with higher delta LV dP/dtmax (mean difference, 1.82; 95% CI, 0.24–3.39; P = .0240) with respect to BiV. MPP and BiV have no significantly different effect on left ventricular end-systolic volume (LVESV) (mean difference, 0.39; 95% CI, -11.12 to 11.89; P = .9475); moreover, there is no significant difference between the 2 treatments regarding hospitalization for HF (odds ratio, 0.70; 95% CI, 0.32 to 1.54; P = .3816) and all-cause death (odds ratio, 0.81; 95% CI, 0.40 to 1.62; P = .5460). MPP is associated with a significantly lower projected battery longevity (mean difference -8.66 months; 95% CI, -13.67 to -3.66; P = .00007) with respect to BiV. Conclusion MPP significantly improves functional class and acute hemodynamic parameters with respect to BiV. Prognostic indices and LVESV are not significantly influenced by MPP. MPP is associated with a significant reduction in projected battery longevity.
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8
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Drucker MN, Manyam H, Singh G, Glascock DN, Gillett S, Miller C, Sharmin K, Parks KA. MultiPole pacing in non-responders to cardiac resynchronization therapy: Results from the QP ExCELs/MPP sub-study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1683-1690. [PMID: 34405423 DOI: 10.1111/pace.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multisite LV stimulation therapy allows for stimulation of two different left ventricular pacing vectors within a single LV lead and may improve responsiveness to cardiac resynchronization therapy (CRT). This study prospectively evaluated the safety and efficacy of the MultiPole Pacing (MPP) feature in CRT non-responder patients. METHODS AND RESULTS CRT non-responders with a standard CRT-D indication were eligible for enrollment into the MPP Sub-Study. Patient status, NYHA classification, Patient Global Assessment (PGA), and adverse events were collected at follow-up. A clinical composite score (CCS) was determined at the 6 month follow-up visit. The primary objective was defined as the proportion of patients with an improved CCS. Safety was evaluated as freedom from MPP system related adverse events requiring additional invasive intervention to resolve. A total of 53 patients were enrolled across 26 U.S. centers. The cumulative follow-up duration was 24.1 years. CCS was improved in 35.6% of patients (p < .0001 when compared to a performance goal of 3%) after 6 months of MPP therapy. When incorporating patient feedback into a modified CCS, 60.0% of patients showed an improvement. Three patients (5.7%) experienced hospitalization for heart failure, and three patient deaths occurred over the follow-up period. No MPP system-related events were reported for an AE-free rate of 100% (95% CI 93.28% to 100.0%). CONCLUSIONS The results of this small, non-randomized study suggest that the MPP feature is safe, and may be effective at converting a percentage of CRT non-responders to responders. Larger, randomized studies are needed to confirm this result.
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Affiliation(s)
| | | | | | | | | | | | | | - Kimberly A Parks
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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Mehta VS, Elliott MK, Sidhu BS, Gould J, Porter B, Niederer S, Rinaldi CA. Multipoint pacing for cardiac resynchronisation therapy in patients with heart failure: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021; 32:2577-2589. [PMID: 34379350 DOI: 10.1111/jce.15199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Multipoint pacing (MPP) has been proposed as an effective way to improve cardiac resynchronisation therapy (CRT) response. We performed a systematic review and meta-analysis evaluating the efficacy of CRT delivered via MPP compared to conventional CRT. METHODS A literature search was performed from inception to January 2021 for studies in Medline, Embase and Cochrane databases, comparing MPP to conventional CRT with a minimum of 6 months follow-up. Randomised and nonrandomised studies were assessed for relevant efficacy data including echocardiographic (left ventricular end systolic volume [LVESV] and ejection fraction) or functional changes (New York Heart Association [NYHA] class/Clinical Composite Score). Subgroup analyses were performed by study design and programming type. RESULTS A total of 7 studies with a total of 1390 patients were included in the final analysis. Overall, MPP demonstrated greater echocardiographic improvement than conventional CRT in nonrandomised studies (odds ratio [OR]: 5.33, 95% confidence interval [CI]: [3.05-9.33], p < .001), however, was not significant in randomised studies (OR: 1.86, 95% CI: [0.91-3.79], p = .086). There was no significant difference in LVESV reduction >15% (OR: 1.96, 95% CI: [0.69-5.55], p = .20) or improvement by ≥1 NYHA class (OR: 2.49, 95% CI: [0.74-8.42], p = .141) when comparing MPP to conventional CRT. In a sub analysis, MPP programmed by widest anatomical separation (MPP-AS) signalled greater efficacy, however, only 120 patients were included in this analysis. CONCLUSION Overall MPP was more efficacious in nonrandomised studies, and not superior when assessed in randomised studies. There was considerable heterogeneity in study design making overall interpretation of results challenging. Widespread MPP programming in all CRT patients is currently not justified. Further large, randomised studies with patient-specific programming may clarify its effectiveness.
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Affiliation(s)
- Vishal S Mehta
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Mark K Elliott
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Baldeep S Sidhu
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Justin Gould
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Bradley Porter
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Steven Niederer
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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10
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Herweg B, Welter-Frost A, Vijayaraman P. The evolution of cardiac resynchronization therapy and an introduction to conduction system pacing: a conceptual review. Europace 2021; 23:496-510. [PMID: 33247913 DOI: 10.1093/europace/euaa264] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 01/14/2023] Open
Abstract
In chronic systolic heart failure and conduction system disease, cardiac resynchronization therapy (CRT) is the only known non-pharmacologic heart failure therapy that improves cardiac function, functional capacity, and survival while decreasing cardiac workload and hospitalization rates. While conventional bi-ventricular pacing has been shown to benefit patients with heart failure and conduction system disease, there are limitations to its therapeutic success, resulting in widely variable clinical response. Limitations of conventional CRT evolve around myocardial scar, fibrosis, and inability to effectively simulate diseased tissue. Studies have shown endocardial stimulation in closer proximity to the specialized conduction system is more effective when compared with epicardial stimulation. Several observational and acute haemodynamic studies have demonstrated improved electrical resynchronization and echocardiographic response with conduction system pacing (CSP). Our objective is to provide a systematic review of the evolution of CRT, and an introduction to CSP as an intriguing, though experimental physiologic alternative to conventional CRT.
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Affiliation(s)
- Bengt Herweg
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606, USA.,Tampa General Hospital, USF Health South Tampa Center, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Allan Welter-Frost
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, South Tampa Center, 2 Tampa General Circle, Tampa, FL 33606, USA.,Tampa General Hospital, USF Health South Tampa Center, 1 Tampa General Circle, Tampa, FL 33606, USA
| | - Pugazhendhi Vijayaraman
- Division of Cardiology, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 E Mountain Blvd, Wilkes-Barre, PA 18711, USA
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11
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Marques P, Nunes-Ferreira A, Silvério António P, Aguiar-Ricardo I, Rodrigues T, Badie N, Marcos I, Bernardes A, Pinto FJ, de Sousa J. Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1577-1584. [PMID: 34255874 DOI: 10.1111/pace.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy demonstrated benefits in heart failure. However, only 60-70% are responders and only 22% are super-responders. MultiPoint pacing (MPP) improves structural remodeling, but data in responder patients is scarce. METHODS A prospective, randomized study of the efficacy of MPP was conducted in patients who were CRT responders after 6 months of bi-ventricular (BiV) therapy. At 6 months, responder patients (LV end-systolic volume [LVESV] reduction ≥15%) were randomized to either continued BiV therapy or to MPP programmed with wide anatomical separation ≥30 mm, and followed until 12 months. Efficacy was determined by 6-12 month changes in LVESV and LV ejection fraction (LVEF). Evaluations of super-responder rate (LVESV reduction ≥30%) and quality of life (NYHA, EQ-5D, MLHFQ) were also performed. RESULTS From February 2017 to February 2019, 73 CRTs with Quartet LV leads were implanted (42.9% female, 65.7 ± 10.8 years old, 79.5% dilated cardiomyopathy). At 6 months, 74.2% responded to BiV and were randomized to BiV (n = 25) or MPP (n = 24). MPP versus BiV delivered greater LVESV improvement (8.3% decrease in MPP vs. 10.3% increase in BiV patients, p = .047), greater increase in LVEF (7.7% vs. 1.8%, p = .008), and higher 0-12 month super-responder rate (86.4% vs. 56.0%, p = .027). More MPP vs. BiV patients experienced an improvement in NYHA (84.6% vs. 50.0%, p = .047) and EQ-5D (94.4% vs. 54.0%, p = .006). CONCLUSIONS MPP with wide anatomical spacing in CRT responder patients resulted in improved LV reverse remodeling with higher rates of super-responders, and better quality of life metrics.
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Affiliation(s)
- Pedro Marques
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Silvério António
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | | | - Ivo Marcos
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Bernardes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
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12
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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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Ghossein MA, van Stipdonk AMW, Plesinger F, Kloosterman M, Wouters PC, Salden OAE, Meine M, Maass AH, Prinzen FW, Vernooy K. Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response. J Cardiovasc Electrophysiol 2021; 32:813-822. [PMID: 33476467 PMCID: PMC7986123 DOI: 10.1111/jce.14910] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Recent studies have shown that the baseline QRS area is associated with the clinical response after cardiac resynchronization therapy (CRT). In this study, we investigated the association of QRS area reduction (∆QRS area) after CRT with the outcome. We hypothesize that a larger ∆QRS area is associated with a better survival and echocardiographic response. METHODS AND RESULTS Electrocardiograms (ECG) obtained before and 2-12 months after CRT from 1299 patients in a multi-center CRT-registry were analyzed. The QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECGs. The primary endpoint was a combination of all-cause mortality, heart transplantation, and left ventricular (LV) assist device implantation. The secondary endpoint was the echocardiographic response, defined as LV end-systolic volume reduction ≥ of 15%. Patients with ∆QRS area above the optimal cut-off value (62 µVs) had a lower risk of reaching the primary endpoint (hazard ratio: 0.43; confidence interval [CI] 0.33-0.56, p < .001), and a higher chance of echocardiographic response (odds ratio [OR] 3.3;CI 2.4-4.6, p < .0001). In multivariable analysis, ∆QRS area was independently associated with both endpoints. In patients with baseline QRS area ≥109 µVs, survival, and echocardiographic response were better when the ∆QRS area was ≥62 µVs (p < .0001). Logistic regression showed that in patients with baseline QRS area ≥109 µVs, ∆QRS area was the only significant predictor of survival (OR: 0.981; CI: 0.967-0.994, p = .006). CONCLUSION ∆QRS area is an independent determinant of CRT response, especially in patients with a large baseline QRS area. Failure to achieve a large QRS area reduction with CRT is associated with a poor clinical outcome.
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Affiliation(s)
- Mohammed A. Ghossein
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Antonius M. W. van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical Centre+MaastrichtThe Netherlands
| | - Filip Plesinger
- Department of Medical SignalsInstitute of Scientific Instruments of the Czech Academy of SciencesBrnoCzech Republic
| | - Mariëlle Kloosterman
- Department of Cardiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Philippe C. Wouters
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Odette A. E. Salden
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Mathias Meine
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Alexander H. Maass
- Department of Cardiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical Centre+MaastrichtThe Netherlands
- Department of CardiologyRadboud University Medical CentreNijmegenThe Netherlands
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14
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San Antonio R, Guasch E, González-Ascaso A, Jiménez-Arjona R, Climent AM, Pujol-López M, Doltra A, Alarcón F, Garre P, Liberos A, Trotta O, Quinto L, Borràs R, Arbelo E, Roca-Luque I, Atienza F, Brugada J, Fernández-Avilés F, Guillem MS, Sitges M, Tolosana JM, Mont L. Optimized single-point left ventricular pacing leads to improved resynchronization compared with multipoint pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:519-527. [PMID: 33538337 DOI: 10.1111/pace.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. METHODS This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. RESULTS The SPP-FOI method achieved greater QRS shortening than MPP (-56 ± 16 vs. -42 ± 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: -58 ± 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 ± 2.3 vs. 6.3 ± 2.0 years, p = .03). CONCLUSIONS SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP.
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Affiliation(s)
- Rodolfo San Antonio
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ana González-Ascaso
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Rafael Jiménez-Arjona
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Andreu M Climent
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Margarida Pujol-López
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Adelina Doltra
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Paz Garre
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Alejandro Liberos
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Omar Trotta
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Levio Quinto
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Roger Borràs
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Felipe Atienza
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, Instituto de Investigación Sanitaria Gregorio Marañon (IISGM), Madrid, Spain
| | - Josep Brugada
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Fernández-Avilés
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, Instituto de Investigación Sanitaria Gregorio Marañon (IISGM), Madrid, Spain
| | - María S Guillem
- ITACA Institute, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Spain
| | - Marta Sitges
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jose María Tolosana
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Lluís Mont
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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15
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Corbisiero R, Mathew A, Bickert C, Muller D. Multipoint Pacing with Fusion-optimized Cardiac Resynchronization Therapy: Using It All to Narrow QRS Duration. J Innov Card Rhythm Manag 2021; 12:4355-4362. [PMID: 33520350 PMCID: PMC7834044 DOI: 10.19102/icrm.2021.120102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
Adaptive atrioventricular (AV)-shortening algorithms have achieved QRS duration (QRSd) narrowing in traditional cardiac resynchronization therapy (CRT) patients. Multipoint pacing (MPP) has also demonstrated benefit in this population. An additional site of activation via intrinsic conduction of the septum may further contribute to CRT; however, the incorporation of all strategies together has yet to be explored. We therefore developed and tested a method combining MPP-CRT and controlled septal contribution to create a multifuse pacing (MFP) technique, establishing four ventricular activation sites for CRT patients using measurements from intracardiac electrograms (EGMs) and incorporating an AV-delay shortening algorithm (SyncAV™; Abbott Laboratories, Chicago, IL, USA) to narrow the QRSd. Patients in sinus rhythm with an AV conduction time of less than 350 ms were included in this analysis and were further stratified by strictly defined left bundle branch block (sLBBB) or nonspecific intraventricular conduction delay (IVCD). EGM-based measurements to determine the QRS septal onset to right ventricular (RV) time (SRAT) and the left ventricular (LV) to RV pacing conduction time were collected and applied to a formula to facilitate MFP. QRSd was compared between before and after programming. A total of 22 patients (19 men and three women) with similar baseline characteristics were compared (all values in mean ± standard deviation). The overall baseline QRSd of 153.31 ± 24.60 ms was decreased to 115.31 ± 16.31 ms after MFP programming (p < 0.0001). The measured SRAT was 59.40 ± 28.49 ms, resulting in a negative AV offset of −20.0 ± 24.97 ms. Patients in the sLBBB group (n = 7) were aged 67.8 ± 13.3 years and had a QRSd of 168.85 ± 27.29 ms that decreased to 113 ± 16.69 ms for a reduction of 55.42 ± 19.3 ms or 32.1% (p = 0.0003). In the IVCD group (n = 15), the baseline QRSd of 146.06 ± 20.29 ms was decreased to 116 ± 16.66 ms for a reduction of 30.07 ± 16.41 ms or 20.62% (p = 0.0001). When comparing the sLBBB and IVCD groups, the sLBBB group was favored by a reduction of 25.35 ms (p = 0.00046). Ultimately, MFP achieved statistically significant reductions in QRSd in all patients tested in this analysis. The benefit was also significantly better in the sLBBB group as compared with in the IVCD group.
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16
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Yagishita D, Yagishita Y, Kataoka S, Yazaki K, Kanai M, Ejima K, Shoda M, Hagiwara N. Left Ventricular Stimulation With Electrical Latency Predicts Mortality in Patients Undergoing Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2021; 7:796-805. [PMID: 34167755 DOI: 10.1016/j.jacep.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/08/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to evaluate the prognostic value of the time interval from left ventricular (LV) pacing to the earliest onset of QRS complex (S-QRS) for long-term clinical outcomes in patients who underwent cardiac resynchronization therapy (CRT). BACKGROUND The electrical latency during LV pacing evaluated by S-QRS is associated with local tissue property, and the S-QRS ≥37 ms has been previously proposed as an independent predictor of mechanical response to CRT. METHODS This study included 82 consecutive patients with heart failure with reduced LV ejection fraction (≤35%) and a wide QRS complex (≥120 ms) who underwent CRT. Patients were divided into a short S-QRS group (SS-QRS; <37 ms) and a long S-QRS group (LS-QRS; ≥37 ms). The primary endpoint was total mortality, including LV assist device implantation or heart transplantation, whereas the secondary endpoint was total mortality or HF hospitalization. RESULTS S-QRS was 25.9 ± 5.3 ms in SS-QRS and 51.5 ± 13.7 ms in LS-QRS (p < 0.01), and baseline QRS duration and electrical activation at the LV pacing site (i.e., Q-LV) were similar. During mean follow-up of 44.5 ± 21.1 months, 24 patients (29%) reached the primary endpoint, whereas the secondary endpoints were observed in 47 patients (57%). LS-QRS had significantly worse event-free survival for both endpoints. LS-QRS was an independent predictor of total mortality (hazard ratio: 2.6; 95% confidence interval: 1.11 to 6.12; p = 0.03) and the secondary composite events (hazard ratio: 2.4; 95% confidence interval: 1.31 to 4.33; p < 0.01). CONCLUSIONS The S-QRS ≥37 ms at the LV pacing site was a significant predictor of total mortality and HF hospitalization. S-QRS-guided optimal LV lead placement is critical in patients who receive CRT.
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Affiliation(s)
- Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshimi Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Tokyo, Japan.
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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17
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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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18
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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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19
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Burger H, Pecha S, Hakmi S, Opalka B, Schoenburg M, Ziegelhoeffer T. Five-year follow-up of transvenous and epicardial left ventricular leads: experience with more than 1000 leads. Interact Cardiovasc Thorac Surg 2020; 30:74-80. [PMID: 31633187 DOI: 10.1093/icvts/ivz239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Transvenous coronary sinus leads are considered to be the gold standard for cardiac resynchronization therapy (CRT). However, in patients with abnormal coronary vein anatomy, the epicardial leads can be an alternative. Data comparing durability and performance of these 2 lead types are limited. In order to provide clarity, we investigated patients receiving CRT system in our centre. METHODS One thousand and fifty-three consecutive patients scheduled for CRT implantation were retrospectively analysed. From these, 895 received transvenous coronary sinus and 158 epicardial left ventricular (LV) leads. Lead-specific as well as LV functional parameters have been evaluated in 60 months' follow-up. RESULTS Technical characteristics (pacing threshold, impedance and sensing) of both lead types remained stable during the whole observation period. Whereas an early revision (<6 month) was noted in 5.4% of transvenous leads, no reintervention has been necessary for epicardial leads. During the 5-year observation period, a lead revisions rate of 10.2% for transvenous leads and 1.9% for epicardial leads were detected. Regarding CRT efficacy, excellent results were achieved for both electrode types. In both groups, a statistically significant reduction of New York Heart Association class (2.85-2.13 and 2.96-2.09), increase in left ventricular ejection fraction (24.6-32.6% and 27.2-34.6%), reduction of left ventricular end-systolic diameter/left ventricular end-diastolic diameter and reduction in degree of mitral valve insufficiency could be observed over the time. CONCLUSIONS Our data demonstrate safety and functional efficacy of both transvenous and epicardial leads. Moreover, in long-term follow-up, a commendable durability and performance were found for both lead types. Thus, epicardial leads represent a good alternative when transvenous implantation fails.
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Affiliation(s)
- Heiko Burger
- Department of Heart Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Bastian Opalka
- Department of Anesthesia, Kerckhoff-Klinik, Bad Nauheim, Germany.,Department of Anesthesia, Kreiskliniken, Darmstadt-Dieburg, Germany
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20
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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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21
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Solimene F, Nigro G, Canciello M, Tavoletta V, Shopova G, Calvanese R, Rago A, La Rosa C, Nappi F, Viscusi M, Urraro F, Manzo G, Gallo P, Andriani A, Rovaris G, Palmisano P, Innocenti S, D'Onofrio A. Design and rationale of the Impact of MultiPoint pacing in CRT patients with reduced RV-to-LV delay (IMAGE-CRT) study. J Cardiovasc Med (Hagerstown) 2020; 21:250-258. [PMID: 32004245 DOI: 10.2459/jcm.0000000000000928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration. A biventricular device is implanted to achieve faster activation and more synchronous contraction of the ventricles. Despite the convincing effect of CRT, 30-40% of patients do not respond. We decided to investigate the role of multipoint pacing (MPP) in a selected group of patients with right ventricle (RV)-to-left ventricle (LV) intervals less than 80 ms that do not respond to traditional CRT. METHODS We will enrol 248 patients in this patient-blinded, observational, clinical study aiming to investigate if MPP could decrease LV end-systolic volume (ESV) in patients with RV-to-LV interval less than 80 ms. MPP will be activated ON at implant in patients with RV-to-LV delay less than 80 ms and OFF in RV-to-LV at least 80 ms. At follow-up the activation of MPP will be related to CRT response. The primary study endpoint will be the responder rate at 6 months, defined as a decrease in LV ejection fraction, LV end-diastolic volume, LV end-systolic volume (LVESV) at least 15% from baseline. Secondary outcomes include 12 months relative percentage reduction in LVESV and a combined clinical outcome measure of response to CRT defined as the patient being alive, no hospitalization due to heart failure, and experiencing an improvement in New York Heart Association functional class (Composite-Score). CONCLUSION Reducing the nonresponder rate continues to be an important goal for CRT.If an increase in reverse remodelling can be achieved by MPP, this study supports the conduct of larger trials investigating the role of MPP on clinical outcomes in selected patients treated, right now, only with traditional CRT. TRIAL REGISTRATION ClinicalTrials.gov, NCT02713308. Registered on 18 March 2016.
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Affiliation(s)
| | - Gerardo Nigro
- University of Campania 'Luigi Vanvitelli', Monaldi Hospital
| | | | | | | | | | - Anna Rago
- University of Campania 'Luigi Vanvitelli', Monaldi Hospital
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22
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Noheria A, Sodhi S, Orme GJ. The Evolving Role of Electrocardiography in Cardiac Resynchronization Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:91. [DOI: 10.1007/s11936-019-0784-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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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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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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Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more. Herz 2019; 43:415-422. [PMID: 29744528 DOI: 10.1007/s00059-018-4710-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.
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Ziacchi M, Palmisano P, Biffi M, Guerra F, Stabile G, Forleo GB, Zanotto G, D'Onofrio A, Landolina M, De Ponti R, Zoni Berisso M, Ricci RP, Boriani G. Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing). Expert Rev Med Devices 2019; 16:821-828. [PMID: 31348864 DOI: 10.1080/17434440.2019.1649134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters. Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation. Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous. Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators' majority want to disposition all kind of leads, although quadripolar leads are the favorites.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | | | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University , Ancona , Italy
| | | | | | | | | | | | - Roberto De Ponti
- Department of Heart and Vessels, Circolo Hospital, University of Insubria , Varese , Italy
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena , Italy
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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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Multipoint left ventricular pacing with large anatomical separation improves reverse remodeling and response to cardiac resynchronization therapy in responders and non-responders to conventional biventricular pacing. Clin Res Cardiol 2019; 109:183-193. [DOI: 10.1007/s00392-019-01499-7] [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: 02/09/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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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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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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Cotarlan V, Johnson F, Goerbig-Campbell J, Light-McGroary K, Inampudi C, Franzwa J, Jenn K, Johnson C, Tandon R, Tahir R, Nabeel Y, Emerenini U, Giudici M. Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices. Am J Cardiol 2019; 123:93-99. [PMID: 30539750 DOI: 10.1016/j.amjcard.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
The benefit of cardiac resynchronization therapy in patients supported by a left ventricular assist device (LVAD) is unknown. There are currently no guidelines regarding the continuation, discontinuation or pacemaker (PM) settings post-LVAD implant. The aim of the study was to assess the hemodynamic benefit of biventricular (BiV) pacing in LVAD patients. We studied 22 patients supported by LVADs (age 62 ± 9, 21 males) who had received a BiV PM before LVAD implant. A total of 123 complete sets of hemodynamics were obtained during BiV pacing (n = 54), right ventricular (RV) pacing (n = 54), and intrinsic rhythm (n = 15). There were no significant differences in right atrial (RA) pressure, mean pulmonary artery pressure (mPA), PCWP, cardiac output, PA saturation (PASat) and right ventricular stroke work index between BiV and RV pacing. Hemodynamics obtained during intrinsic rhythm in 15 non-PM-dependent patients were not significantly different compared with those obtained during BiV or RV pacing. Furthermore, hemodynamics were similar at different heart rates ranging 50 to 110 beats/min. Right ventricular stroke work index was significantly lower at the highest heart rate compared with baseline and lowest heart rates suggesting decreased RV performance at higher heart rate. In conclusion, BiV pacing does not have any acute hemodynamic benefit compared with RV pacing or intrinsic rhythm in LVAD patients. A lower heart rate may confer better RV performance.
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Pombo Jiménez M, Cano Pérez O, Lorente Carreño D, Chimeno García J. Registro Español de Marcapasos. XV Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2017). Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Optimization of coronary sinus lead placement targeted to right-to-left delay in patients undergoing cardiac resynchronization therapy. Europace 2018; 21:502-510. [DOI: 10.1093/europace/euy275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/18/2018] [Indexed: 11/14/2022] Open
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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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Niederer SA, Rinaldi CA. Is CRT response rate all about patient selection? Int J Cardiol 2018; 270:183-184. [PMID: 29960761 DOI: 10.1016/j.ijcard.2018.06.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE1 7EH, United Kingdom.
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE1 7EH, United Kingdom; Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom
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Improved acute haemodynamic response to cardiac resynchronization therapy using multipoint pacing cannot solely be explained by better resynchronization. J Electrocardiol 2018; 51:S61-S66. [DOI: 10.1016/j.jelectrocard.2018.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/06/2018] [Accepted: 07/14/2018] [Indexed: 11/18/2022]
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37
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Santini M, Santini L, Di Fusco SA. Update on cardiac implantable electronic devices: from the injectable loop recorder to the leadless pacemaker, to the subcutaneous defibrillator. Minerva Cardioangiol 2018; 66:762-769. [DOI: 10.23736/s0026-4725.18.04693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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38
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Spanish Pacemaker Registry. 15th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2017). ACTA ACUST UNITED AC 2018; 71:1059-1068. [PMID: 30348615 DOI: 10.1016/j.rec.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES This report describes the data reported to the Spanish Pacemaker Registry concerning the activity in cardiac pacing in 2017 in Spain. METHODS The analysis is based on the data obtained from the European Pacemaker Identification Card and the information reported by supplier companies related to global number of implanted pacemakers. RESULTS Information was received from 106 hospitals, with a total of 12672 cards, representing the 32.1% of the total pacing activity. Conventional pacemaker and resynchronization pacemaker rate was 820 units/million and 26 units/million inhabitants respectively. A total of 333 leadless pacemakers were implanted. The mean age was 77.9 years, predominantly men (58.5%). Most electrodes were bipolar, with active fixation and only 20% had magnetic resonance protection. Atrioventricular block was the most common electrocardiographic disturb. Most patients received bicameral sequential pacing although single chamber VVIR pacing was used in up to 21.8% of patients. Patients older than 80 years benefited less from physiological pacing and resynchronization therapy. CONCLUSIONS Total use of pacemaker generators remains stable with respect to 2016. Age is the main factor that influences pacing mode selection, which could be improved in around 22% of patients. Leadless pacing continues to rise.
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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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40
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Multisite pacing: Have we reached the tipping point of managing cardiac resynchronization therapy nonresponders? Heart Rhythm 2018; 15:1775-1776. [PMID: 29990593 DOI: 10.1016/j.hrthm.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 11/23/2022]
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41
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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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Auricchio A, Heggermont WA. Avances tecnológicos para mejorar la respuesta ventricular en la resincronización cardiaca: lo que el clínico debe conocer. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Pushing and recognizing the limits of nonresponse to cardiac resynchronization therapy: A valuable “negative” trial. Heart Rhythm 2018; 15:877-878. [DOI: 10.1016/j.hrthm.2018.01.026] [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: 01/20/2018] [Indexed: 11/21/2022]
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44
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Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy. Int J Cardiol 2018; 260:82-87. [DOI: 10.1016/j.ijcard.2018.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/18/2018] [Accepted: 02/02/2018] [Indexed: 12/28/2022]
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45
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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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van Everdingen WM, Zweerink A, Cramer MJ, Doevendans PA, Nguyên UC, van Rossum AC, Prinzen FW, Vernooy K, Allaart CP, Meine M. Can We Use the Intrinsic Left Ventricular Delay (QLV) to Optimize the Pacing Configuration for Cardiac Resynchronization Therapy With a Quadripolar Left Ventricular Lead? Circ Arrhythm Electrophysiol 2018; 11:e005912. [DOI: 10.1161/circep.117.005912] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Wouter M. van Everdingen
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Alwin Zweerink
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Maarten J. Cramer
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Pieter A. Doevendans
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Uyên Châu Nguyên
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Albert C. van Rossum
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Frits W. Prinzen
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Kevin Vernooy
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Cornelis P. Allaart
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
| | - Mathias Meine
- From the Department of Cardiology, University Medical Center Utrecht, The Netherlands (W.M.v.E., M.J.C., P.A.D., M.M.); Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (A.Z., A.C.v.R., C.P.A.); Department of Cardiology, Maastricht University Medical Center, The Netherlands (U.C.N., K.V.); and Department of Physiology, CARIM (Cardiovascular Research Institute Maastricht), Maastricht University, The Netherlands (U.C.N., F.W.P.)
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Auricchio A, Heggermont WA. Technology Advances to Improve Response to Cardiac Resynchronization Therapy: What Clinicians Should Know. ACTA ACUST UNITED AC 2018; 71:477-484. [PMID: 29454549 DOI: 10.1016/j.rec.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/21/2017] [Indexed: 02/01/2023]
Abstract
Cardiac resynchronization therapy (CRT) is a well-established treatment for symptomatic heart failure patients with reduced left ventricular ejection fraction, prolonged QRS duration, and abnormal QRS morphology. The ultimate goals of modern CRT are to improve the proportion of patients responding to CRT and to maximize the response to CRT in patients who do respond. While the rate of CRT nonresponders has moderately but progressively decreased over the last 20 years, mostly in patients with left bundle branch block, in patients without left bundle branch block the response rate is almost unchanged. A number of technological advances have already contributed to achieve some of the objectives of modern CRT. They include novel lead design (the left ventricular quadripolar lead, and multipoint pacing), or the possibility to go beyond conventional delivery of CRT (left ventricular endocardial pacing, His bundle pacing). Furthermore, to improve CRT response, a triad of actions is paramount: reducing the burden of atrial fibrillation, reducing the number of appropriate and inappropriate interventions, and adequately predicting heart failure episodes. As in other fields of cardiology, technology and innovations for CRT delivery have been at the forefront in transforming-improving-patient care; therefore, these innovations are discussed in this review.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiac Electrophysiology, Cardiocentro Ticino, Lugano, Switzerland; Center for Computational Medicine in Cardiology, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Ward A Heggermont
- Division of Cardiac Electrophysiology, Cardiocentro Ticino, Lugano, Switzerland; Cardiovascular Research Center, OLV Hospital Aalst, Aalst, Belgium
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Socie P, Squara F, Semichon M, Thomas O, Khemache A, Riccini P, Squara P, Algalarrondo V, Moubarak G. Combination of the best pacing configuration and atrioventricular and interventricular delays optimization in cardiac resynchronization therapy. Pacing Clin Electrophysiol 2018; 41:362-367. [PMID: 29405324 DOI: 10.1111/pace.13294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/13/2018] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy optimization can be pursued by left ventricular pacing vector selection and atrioventricular (AV) and interventricular (VV) delays optimization. The combination of these methods and its comparison with multipoint pacing (MPP) is scarcely studied. METHODS Using noninvasive cardiac output (CO) measurement, the best of five left ventricular pacing vectors was determined, then AV and VV delays optimization was applied on top of the best vector. Response to the optimization protocol was defined as a >5% CO increase compared to the standard biventricular configuration. RESULTS Twenty-two patients (18 men, age 71 ± 9 years) were included. Standard biventricular configuration increased CO compared to baseline (4.65 ± 1.55 L/min vs 4.27 ± 1.53 L/min, respectively, P = 0.02). The best quadripolar configuration increased CO to 4.85 ± 1.67 L/min (P = 0.03 compared to the standard biventricular configuration). AV then VV delay optimization both provided additional benefit (final CO 5.56 ± 2.03 L/min, P = 0.001 compared to the best quadripolar configuration). Fifteen (68%) patients responded to the optimization protocol. Anatomical MPP (based on maximal anatomical separation between electrodes) and electrical MPP (based on maximal electrical activation difference between electrodes) were evaluated in 16 patients and yielded a CO similar to that of the optimization procedure. CONCLUSIONS The combination of choosing the best quadripolar pacing configuration and optimizing atrioventricular and interventricular delays resulted in an improvement of cardiac output compared to standard biventricular stimulation in 68% of patients. The final cardiac output was comparable to multipoint pacing.
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Affiliation(s)
- Pierre Socie
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Fabien Squara
- Department of Cardiology, Pasteur University Hospital, Nice, France
| | - Marc Semichon
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Thomas
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Alain Khemache
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Philippe Riccini
- Department of Cardiology, Pasteur University Hospital, Nice, France
| | - Pierre Squara
- Intensive Care Unit, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Vincent Algalarrondo
- Department of Cardiology, Antoine Béclère Hospital, Université Paris-Sud, Clamart, France
| | - Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
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Rowe MK, Kaye GC. Advances in atrioventricular and interventricular optimization of cardiac resynchronization therapy - what's the gold standard? Expert Rev Cardiovasc Ther 2018; 16:183-196. [PMID: 29338475 DOI: 10.1080/14779072.2018.1427582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is one of the most important advances in heart failure management in the last twenty years. Approximately one-third of patients appear not to respond to therapy. Although there are a number of possible mechanisms for non-response, an important factor is suboptimal atrioventricular (AV) and interventricular (VV) timing intervals. There remains controversy over whether routinely optimizing intervals is necessary and there is no agreed gold standard methodology. Optimization has classically been performed using echocardiography which has limits related to resource use, time-cost and variable reproducibility. Newer optimization methods using device-based sensors and algorithms show promise in reducing heart-failure hospitalization compared with echocardiography. Areas covered: This review outlines the rationale for optimization, the principles of AV and VV optimization, the standard echocardiographic approach and newer device-based algorithms and the evidence base for their use. Expert commentary: The incremental gains of optimization are likely to be real, but small, compared to the overall improvement gained from cardiac resynchronization itself. At this time routine optimization may not be mandatory but should be performed where there is no response to CRT. Device-based optimization algorithms appear to be practical and in some cases, deliver superior clinical outcomes compared to echocardiography.
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Affiliation(s)
- Matthew K Rowe
- a Department of Cardiology , Princess Alexandra Hospital , Brisbane , Australia.,b Faculty of Medicine , The University of Queensland , Brisbane , Australia
| | - Gerald C Kaye
- a Department of Cardiology , Princess Alexandra Hospital , Brisbane , Australia.,b Faculty of Medicine , The University of Queensland , Brisbane , Australia
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50
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Niazi I, Baker J, Corbisiero R, Love C, Martin D, Sheppard R, Worley SJ, Varma N, Lee K, Tomassoni G. Safety and Efficacy of Multipoint Pacing in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2017; 3:1510-1518. [DOI: 10.1016/j.jacep.2017.06.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 10/18/2022]
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