In Heart Failure Patients with Left Bundle Branch Block Single Lead MultiSpot Left Ventricular Pacing Does Not
Maciej Sterliński1, Adam Sokal2, Radosław Lenarczyk2
1The Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
Insights
MultiSPOT pacing (MSP) showed similar hemodynamic improvements to biventricular pacing (BiV) in patients with left bundle branch block (LBBB). Optimizing atrioventricular delay is crucial for both pacing methods to enhance CRT response.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Cardiac Resynchronization Therapy (CRT) response can be enhanced by multiSPOT pacing (MSP) using multiple electrodes on a single ventricular lead.
- Previous studies on MSP for CRT have yielded inconclusive results regarding its efficacy.
Purpose of the Study:
- To compare the acute hemodynamic response of MSP pacing versus conventional biventricular pacing (BiV) in patients with left bundle branch block (LBBB).
- To evaluate the impact of different pacing configurations and atrioventricular delays on hemodynamic performance.
Main Methods:
- The iSPOT study involved 24 patients with LBBB undergoing acute hemodynamic assessment.
- Hemodynamic response was measured by the percentage change in LV+dP/dtmax during MSP pacing (using 3 electrodes) and conventional BiV pacing (distal, mid, proximal, or all electrodes).
- Measurements were repeated across various atrioventricular delays, alongside QRS width and Q-LV durations.
Main Results:
- MSP pacing resulted in a 31.0±3.3% increase in LV+dP/dtmax, which was not significantly superior to conventional BiV pacing configurations (28.9±3.2% to 29.5±3.0%).
- No significant correlation was found between LV+dP/dtmax and QRS width or Q-LV ratio.
- All patients completed the protocol, with a mean QRS width of 171±20 ms and 58% having ischemic etiology.
Conclusions:
- MultiSPOT LV pacing offers comparable hemodynamic improvements to the best conventional BiV pacing in LBBB patients.
- Optimizing atrioventricular delay is essential for maximizing the performance of both BiV and MSP pacing strategies.
- Further research may be needed to fully elucidate the role of MSP in CRT.
Introduction:
Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive.
Aim:
The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV).
Methods:
Patients with left bundle branch block (LBBB) underwent an acute hemodynamic study to determine the %change in LV+dP/dtmax from baseline atrial pacing compared to the following configurations: BiV pacing with the LV lead in a one of lateral veins, while pacing from the distal, mid, or proximal electrode and all 3 electrodes together (i.e. MSP). All measurements were repeated 4 times at 5 different atrioventricular delays. We also measured QRS-width and individual Q-LV durations.
Results:
Protocol was completed in 24 patients, all with LBBB (QRS width 171±20 ms) and 58% ischemic aetiology. The percentage change in LV+dP/dtmax for MSP pacing was 31.0±3.3% (Mean±SE), which was not significantly superior to any BiV pacing configuration: 28.9±3.2% (LV-distal), 28.3±2.7% (LV-mid), and 29.5±3.0% (LV-prox), respectively. Correlation between LV+dP/dtmax and either QRS-width or Q-LV ratio was poor.
Conclusions:
In patients with LBBB MultiSPOT LV pacing demonstrated comparable improvement in contractility to best conventional BiV pacing. Optimization of atrioventricular delay is important for the best performance for both BiV and MultiSPOT pacing configurations.
Trial Registration:
ClinicalTrials.gov NTC01883141.
