Anodal Capture for Multisite Pacing with a Quadripolar Left Ventricular Lead: A Feasibility Study.

Area of Science:

• Cardiology
• Biomedical Engineering
• Electrophysiology

Background:

• Cardiac resynchronization therapy (CRT) has a significant non-responder rate (up to 40%).
• Multisite pacing (MPP), utilizing quadripolar leads, presents a potential alternative for CRT non-responders.
• The study investigates a novel method to achieve MPP-like effects without specialized algorithms.

Purpose of the Study:

• To assess the feasibility of intentional anodal capture with a single LV quadripolar lead.
• To reproduce MPP effects, termed "pseudo-MPP", without specific algorithms.
• To compare the energy consumption and theoretical longevity of "pseudo-MPP" with conventional MPP and biventricular pacing (BVp).

Main Methods:

• Prospective inclusion of patients with CRT devices and quadripolar LV leads.
• Calculation of electrical charge (Q) for RV and LV pacing configurations at threshold.
• Definition and calculation of energy consumption for best MPP, best "pseudo-MPP", and best BVp.
• Estimation of theoretical device longevity for each pacing configuration.

Main Results:

• "Pseudo-MPP" was feasible in 80% of 15 consecutive patients.
• Multiple pacing vectors were available per patient, with LV_proximal-LV_distal vectors in 47%.
• Energy consumption of "pseudo-MPP" was comparable to conventional MPP (p=0.15). Theoretical longevity was 5.6 years for "pseudo-MPP" vs. 6.2 years for MPP.

Conclusions:

• "Pseudo-MPP" using intentional anodal capture with quadripolar LV leads is feasible in most CRT patients.
• This technique mimics conventional multisite pacing with comparable energy consumption.
• Further research is warranted to evaluate the clinical impact of "pseudo-MPP".