The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results

• Published in: Europace (London, England) Vol. 18; no. 4; pp. 560 - 567
• Main Authors: Osca, Joaquín, Alonso, Pau, Cano, Oscar, Andrés, Ana, Miro, Vicente, Tello, María José Sancho, Olagüe, Jose, Martínez, Luis, Salvador, Antonio
• Format: Journal Article
• Language: English
• Published: England 01-04-2016
• Subjects: Aged; Biomechanical Phenomena; Cardiac Pacing, Artificial - adverse effects; Cardiac Pacing, Artificial - methods; Cardiac Resynchronization Therapy - adverse effects; Cardiac Resynchronization Therapy Devices; Echocardiography; Equipment Design; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Pacemaker, Artificial; Predictive Value of Tests; Prospective Studies; Spain; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Ventricular Function, Left; Cardiac resynchronization; Speckle tracking echocardiography; Dyssynchrony; Multisite pacing
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euv211

The objective of the present study was to evaluate the effect of multipoint pacing (MPP) on acute haemodynamics, cardiac contractility, and left ventricle (LV) dyssynchrony, in comparison with conventional cardiac resynchronization therapy (CRT).
An open-label, non-randomized, single-centre, prospective study was designed. Twenty-seven consecutive patients were included. Evaluation of pacing configurations was performed in a random order. Transthoracic echocardiography was used to obtain haemodynamic and dyssynchrony parameters. Left ventricular ejection fraction (LVEF) was significantly superior in MPP compared with baseline (38.4 ± 1.8% vs. 26.1 ± 2.2%; P < 0.001), and in conventional pacing configuration compared with baseline (33.2 ± 1.8% vs. 26.1 ± 2.2%; P = 0.007). Cardiac index (CI) was increased by 21.8 ± 5.4% and 34.7 ± 5.1% in conventional and MPP configurations, respectively (P = 0.19). Percentage of acute responders (CI increase ≥10%) was 62.9 and 85.2% in conventional and MPP, respectively (P < 0.001). LV dyssynchrony was defined by radial strain rate parameters. Baseline anteroseptal-to-posterior wall time delay was 168 ± 21 ms. It was reduced until 70.4 ± 29 ms in conventional and -6.6 ± 11 ms in MPP (conventional vs. baseline P = 0.04; MPP vs. conventional P = 0.05). Standard deviation of the time-to-peak radial strain of the 6 LV basal segments was 101 ± 9.7, 80.3 ± 9.2, and 66 ± 8.03 ms in baseline, conventional, and MPP configurations, respectively (MPP vs. basal P = 0.012). Finally, we observed a positive correlation (r = 0.69) between reduction in dyssynchrony and CI increase (P < 0.0001).
MPP showed a further reduction in LV dyssynchrony compared with conventional biventricular pacing. Moreover, MPP resulted in an additional improvement in LVEF and in CI, and this was translated into a higher number of acute responders to CRT.