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Related Experiment Video

Updated: Feb 7, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Improved acute haemodynamic response to cardiac resynchronization therapy using multipoint pacing cannot solely be

Elien B Engels1, Annemijn Vis2, Bianca D van Rees2

  • 1Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Department of Medicine, University of Western Ontario, London, Ontario, Canada.

Journal of Electrocardiology
|July 30, 2018
PubMed
Summary

Multipoint pacing (MPP) improves heart function in cardiac resynchronization therapy (CRT) patients by optimizing electrical activation. This benefit is achieved through improved electrical resynchronization or a more dominant left ventricular activation sequence.

Keywords:
Cardiac resynchronization therapyElectrical dyssynchronyMultipoint pacingVectorcardiography

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Quadripolar left ventricular (LV) leads offer multipoint pacing (MPP) to enhance cardiac resynchronization therapy (CRT) benefits.
  • Invasive hemodynamic measurements indicate MPP improves hemodynamic response in CRT patients.

Purpose of the Study:

  • To determine if multipoint pacing (MPP) enhances electrical resynchronization.
  • To investigate the mechanisms behind the hemodynamic improvements observed with MPP.

Main Methods:

  • Evaluated LV lead positions during biventricular (BiV) pacing and MPP in 29 CRT candidates.
  • Simultaneously measured 12-lead ECG and invasive LV pressure curves.
  • Utilized Kors matrix for ECG to vectorcardiogram (VCG) conversion; compared MPP's hemodynamic benefit with QRS duration and VCG-derived QRS area changes.

Main Results:

  • MPP significantly improved hemodynamics compared to BiV pacing in 26 patients, without significant changes in QRS duration or area.
  • In 17 patients, MPP increased QRS area but rotated the maximal QRS vector, suggesting a more LV-dominant activation.
  • Only 5 patients showed reduced QRS area with MPP, indicating electrical resynchronization.

Conclusions:

  • The hemodynamic benefits of MPP over BiV pacing stem from either improved electrical resynchronization (reduced QRS area) or rotation of the maximal QRS vector.
  • A more LV-dominated activation sequence, indicated by vector rotation, was observed in two-thirds of the study cohort.