Key result
Multi-point pacing shows faster LV activation vs standard CRT in ~40% of patients, demonstrating idiosyncratic responses.
Why the study?
Multipoint pacing has yielded mixed results in CRT, making it critical to identify which patients need it and how to configure stimulation for optimal electrical resynchronization.
Does multi-point pacing optimization using non-invasive electrocardiographic imaging improve acute electrical resynchronization compared to standard CRT?
Observational (n=5)
Does multi-point pacing optimization using non-invasive electrocardiographic imaging improve acute electrical resynchronization compared to standard CRT?
Non-invasive ECG imaging demonstrates that the acute electrical effects of multi-point pacing in CRT are highly patient-specific and potentially limited by extensive LV scarring.
MPP responses in CRT appear highly patient-specific; leaves open whether ECG imaging optimization improves resynchronization in prospective trials.
AIM: Quadripolar lead technology and multi-point pacing (MPP) are important clinical adjuncts in cardiac resynchronization therapy (CRT) pacing aimed at reducing the rate of non-response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization. METHODS & RESULTS: inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECGi activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECGi voltage mapping. CONCLUSIONS: Our work suggests a potential role for ECGi in the optimization of non-responders to CRT, as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG.
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Sieniewicz et al. (2019) conducted an observational in Cardiac resynchronization therapy (CRT) (n=5). Multi-point pacing (MPP) guided by non-invasive electrocardiographic imaging (ECGi) vs. Standard CRT was evaluated on Electrical resynchronization (left ventricular activation). Multi-point pacing resulted in more rapid left ventricular activation compared to standard CRT in 2 of 5 patients, demonstrating highly idiosyncratic and patient-specific electrical responses.
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