Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac
Carlo Pappone1, Žarko Ćalović1, Gabriele Vicedomini1
1Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Insights
MultiPoint Pacing (MPP) offers improved cardiac function over conventional CRT. This advanced pacing technique significantly enhances left ventricular (LV) hemodynamics and diastolic function in patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Conventional cardiac resynchronization therapy (CRT) is known to improve acute cardiac hemodynamics.
- Further optimization of CRT may lead to enhanced patient outcomes.
- Left ventricular (LV) pacing strategies are crucial for effective CRT.
Purpose of the Study:
- To evaluate the hemodynamic benefits of MultiPoint Pacing (MPP) compared to conventional CRT.
- To assess if MPP, utilizing a single coronary sinus branch, offers superior hemodynamic improvements.
- To investigate acute changes in LV pressure-volume loop parameters with MPP.
Main Methods:
- Forty-four patients with heart failure (NYHA III, EF 27% ± 6%) received CRT devices.
- Intraoperative LV hemodynamics were assessed using a pressure-volume loop system.
- A pacing protocol compared conventional CRT (CONV) with various MPP configurations against baseline.
Main Results:
- The best MPP configuration significantly increased dP/dtmax (15.9%), stroke work (27.2%), stroke volume (10.4%), and ejection fraction (10.5%) compared to CONV.
- MPP also improved diastolic function, significantly decreasing -dP/dtmin (-13.5%), relaxation time constant (-7.5%), and end-diastolic pressure (-18.2%) versus CONV.
- These improvements were statistically significant (P < .001 for most parameters).
Conclusions:
- Cardiac resynchronization therapy with MultiPoint Pacing (MPP) significantly enhances acute left ventricular hemodynamic parameters.
- MPP demonstrates superior hemodynamic benefits compared to conventional CRT.
- Pressure-volume loop measurements confirm the efficacy of MPP in improving cardiac function.
Background:
Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics.
Objective:
To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients.
Methods:
Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention.
Results:
Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing -dP/dtmin (-13.5% ± 10.2% vs -10.6% ± 6.8%; P = .011), relaxation time constant (-7.5% ± 9.0% vs -4.8% ± 7.2%; P = .012), and end-diastolic pressure (-18.2% ± 22.4% vs -8.7% ± 21.4%; P < .001) as compared with the best CONV intervention.
Conclusions:
CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV.
