Acute Hemodynamic Effects of Simultaneous and Sequential Multi-Point Pacing in Heart Failure Patients With an Expected Higher Rate of Sub-response to Cardiac Resynchronization Therapy: Results of Multicenter SYNSEQ Study

Frontiers in Cardiovascular Medicine

article

Maciej Sterliński¹  Joanna Zakrzewska-Koperska¹  Aleksander Maciąg²  Adam Sokal³  Joaquin Osca-Asensi⁴  Lingwei Wang⁵  Vasiliki Spyropoulou⁶  Baerbel Maus⁶  Francesca Lemme⁶  Osita Okafor⁷  Berthold Stegemann⁸  Richard Cornelussen⁶  Francisco Leyva⁸ 

[1] First Department of Arrhythmia, National Institute of Cardiology;Second Department of Arrhythmia, National Institute of Cardiology;Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center of Heart Disease;Cardiology Department, University and Polytechnic Hospital la Fe;Section of Arrhythmias, Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University;Bakken Research Center;Queen Elisabeth Hospital, Birmingham University;Aston Medical School, Aston Medical Research Institute, Aston University

关键词: heart failure;    biventricular pacing;    quadripolar lead for left ventricle pacing;    multipoint pacing;    acute hemodynamic effect;    cardiac resynchronization therapy;   

DOI  :  10.3389/fcvm.2022.901267

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP syn ) or sequential (3P-MPP seq ) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS ≤ 150 or the absence of LBBB (age: 66 ± 12 years, QRS: 159 ± 12 ms, NYHA class II/III, LVEF ≤ 35%) underwent acute hemodynamic assessment by LV + dP/dt max with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt max (%ΔLV + dP/dt max ) with 3P-MPP syn (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP seq (11.8%, 95% CI: 7.6-16.0%) nor to SPP basal (11.5%, 95% CI:7.1-15.9%) or SPP mid (12.2%, 95% CI:7.9-16.5%), but higher than SPP apical (10.6%, 95% CI:5.3-15.9%, p = 0.03). AHR (defined as a %ΔLV + dP/dt max ≥ 10%) varied between pacing configurations: 36% (9/25) for SPP apical , 44% (11/25) for SPP basal , 54% (13/24) for SPP mid , 56% (14/25) for 3P-MPP syn and 48% (11/23) for 3P-MPP seq.Fifteen patients (15/25, 60%) had an AHR in at least one pacing configuration. AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB ( p = 0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population.

【 授权许可】

CC BY