Improvement in acute contractility and hemodynamics with multipoint pacing via a left ventricular quadripolar pacing lead.
Rinaldi CA., Leclercq C., Kranig W., Kacet S., Betts T., Bordachar P., Gutleben KJ., Shetty A., Donal E., Keel A., Ryu K., Farazi TG., Simon M., Naqvi TZ.
INTRODUCTION: A quadripolar left ventricular (LV) pacing can deliver multipoint pacing (MPP). It is unknown if this confers improved cardiac function compared to conventional cardiac resynchronization therapy (CRT). METHODS AND RESULTS: We aimed to characterize changes in acute cardiac contractility and hemodynamics with multisite left ventricular "multipoint" pacing (MPP) in a prospective multicenter study in patients implanted with a CRT-defibrillator incorporating a quadripolar LV lead. The device was programmed to deliver MPP acutely pacing with eight configurations of varying timing delays. Global peak LV radial strain and LV outflow velocity time integral (LVOT VTI) were measured for conventional CRT and each MPP configuration. Out of the eight tested MPP configurations, the one that yielded the best echocardiographic measurement for each patient was defined as "optimal MPP". Forty CRT recipients had complete radial strain datasets suitable for analysis. Compared to conventional CRT, the mean peak radial strain was significantly higher for the optimal MPP configuration (18.3 ± 7.4 vs. 9.3 ± 5.3%, p < 0.001), and at least one MPP configuration was significantly superior (>20%) in 63% of patients. LVOT VTI data were collected in a subset of 13 patients. In these patients, mean VTI was significantly higher for optimal MPP compared to conventional CRT (13.5 ± 2.7 vs. 10.9 ± 3.3 cm, p < 0.01). CONCLUSION: MPP delivered via a quadripolar LV lead resulted in a significant improvement in acute cardiac contractility and hemodynamics compared to conventional CRT in the majority of patients studied. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01044784.