Document Detail

Multipoint Left Ventricular Pacing in a Single Coronary Sinus Branch Improves Mid-Term Echocardiographic and Clinical Response to Cardiac Resynchronization Therapy.
MedLine Citation:
PMID:  25109276     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MPP) in a single coronary sinus branch improves acute LV function. We hypothesized that MPP can improve mid-term echocardiographic and clinical response compared with conventional CRT.
METHODS AND RESULTS: Consecutive patients receiving a CRT implant (Unify Quadra MP™ or Quadra Assura MP™ CRT-D and Quartet™ LV lead, St. Jude Medical) were randomized to receive biventricular pacing with either conventional LV pacing (CONV group) or MPP (MPP group). For each patient, an optimal pacing configuration for the assigned pacing mode was programmed based on intraoperative pressure-volume loop measurements. A clinical evaluation and transthoracic echocardiogram were performed prior to implant (BASELINE) and at 3 months post-implant and analyzed by a blinded observer. A reduction in end-systolic volume (ESV) of ≥15% relative to BASELINE was prospectively defined as response to CRT. Forty-four patients (NYHA Class III, EF 29±6%, QRS duration 152±17 ms) were enrolled and randomized. One patient in the MPP group was lost to follow-up and excluded from further analysis. After 3 months, 11/22 (50%) CONV patients and 16/21 (76%) MPP patients were classified as responders. ESV reduction, EF increase, and NYHA class reduction relative to BASELINE were significantly greater in the MPP group than in the CONV group (ESV: -21.0±13.9 vs. -12.6±11.1%, p = 0.03; EF: +9.8±5.1 vs. +2.0±7.8 percentage points, p <0.001; ΔNYHA: -1.05±0.22 vs. -0.72±0.46 functional classes, p = 0.006).
CONCLUSION: Pressure-volume loop optimized biventricular pacing with MPP resulted in an improved rate of response to CRT. This article is protected by copyright. All rights reserved.
Carlo Pappone; Zarko Calović; Gabriele Vicedomini; Amarild Cuko; Luke C McSpadden; Kyungmoo Ryu; Enrico Romano; Mario Baldi; Massimo Saviano; Alessia Pappone; Cristiano Ciaccio; Luigi Giannelli; Bogdan Ionescu; Andrea Petretta; Raffaele Vitale; Angelica Fundaliotis; Luigi Tavazzi; Vincenzo Santinelli
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-11
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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