Left Ventricular and Biventricular Multipoint Pacing With Dynamic Atrioventricular Delays: 6-Month Cardiac
Bernard Thibault1, Peter Waddingham2, Nima Badie3
1From the Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Insights
Combining SyncAV CRT with MultiPoint Pacing (MPP) showed promising 6-month results for cardiac resynchronization therapy patients. Both biventricular and LV-only pacing improved echocardiographic and clinical outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Cardiac resynchronization therapy (CRT) response varies with pacing location and timing.
- Dynamic atrioventricular (AV) delays (SyncAV CRT) and multi-site left ventricular (LV) pacing (MPP) may improve CRT outcomes.
- The combined effect of SyncAV and MPP in chronic settings is not well-studied.
Purpose of the Study:
- To evaluate the 6-month echocardiographic and clinical response to SyncAV combined with biventricular MPP (MPP+SyncAV) or LV-only MPP (LVMPP+SyncAV).
Main Methods:
- A multi-center study randomized CRT-indicated patients with LBBB and intact AV conduction.
- Patients received either MPP+SyncAV (RV+LV1+LV2 pacing) or LVMPP+SyncAV (LV1+LV2 pacing).
- SyncAV offsets were optimized to minimize QRS duration; echocardiographic and clinical metrics were assessed at baseline and 6 months.
Main Results:
- 70 patients completed the study (MPP+SyncAV: n=36; LVMPP+SyncAV: n=34).
- Both groups showed comparable improvements in LV end-systolic volume (ESV) and LV ejection fraction (EF) at 6 months.
- Similar positive trends were observed for NYHA class, quality of life (QoL), and Packer scores across both groups.
Conclusions:
- Combining SyncAV with MPP (biventricular or LV-only) demonstrated promising 6-month echocardiographic and clinical response rates in LBBB patients.
- These findings suggest potential benefits of this combined pacing strategy for CRT.
- Further research may explore long-term outcomes and broader patient populations.
Background:
The response to cardiac resynchronization therapy (CRT) can depend on when and where the right and left ventricles (RV, LV) are paced. Dynamic atrioventricular (AV) delays (SyncAV CRT, Abbott) and multi-site LV pacing (e.g., MultiPoint Pacing [MPP], Abbott) are features that may enhance CRT response. Their combined impact has not been evaluated in a chronic clinical setting.
Objective:
Evaluate the 6-month echocardiographic and clinical response to SyncAV when combined with either biventricular MPP (MPP+SyncAV: RV + LV1 + LV2 pacing) or LV-only MPP (LVMPP+SyncAV: LV1 + LV2 pacing).
Methods:
CRT-indicated patients with LBBB and intact AV conduction (PR < 250 ms) were implanted and randomized to either MPP+SyncAV or LVMPP+SyncAV in an international, multi-center clinical study. Patient-specific SyncAV offsets were selected to minimize QRS duration at implant. The following response metrics were captured at baseline and 6 months post-implant: LV end-systolic volume (ESV), LV ejection fraction (EF), NYHA class, quality of life score (QoL), and Packer score.
Results:
CRT implant and 6-month visits were completed in 70 patients (69 years old, 73% male, 179 ms PR, 164 ms QRS). MPP+SyncAV (n = 36) and LVMPP+SyncAV (n = 34) groups demonstrated comparable 6-month response magnitudes and responder rates for ΔESV ≤ -15% (85% vs. 74%) and ΔEF ≥ 5% (94% vs. 77%), as well as improvements in NYHA class (43% vs. 47%), QoL (59% vs. 64%), and Packer score (70% vs. 70%); p > 0.05 for all.
Conclusions:
The 6-month echocardiographic (ESV, EF) and clinical (NYHA class, QoL, Packer) response rates observed in LBBB patients were promising when SyncAV was combined with MPP, in both biventricular and LV-only pacing modes.
Trial Registration:
NCT03567096.
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