Acute Electrical Synchronization Achieved With Dynamic Atrioventricular Delays During Biventricular and Left Ventricular MultiPoint Pacing

Figure 1. Schematic illustrating all potential ventricular pacing combinations evaluated. The LV1 and LV2 show example cathode locations. RA, right atrium; RV, right ventricle.

Figure 2. Patient disposition. CRT, cardiac resynchronization therapy; LV, left ventricular; MPP, MultiPoint Pacing.

Figure 3. LV pacing cathode selections for each pacing configuration. (A) For biventricular pacing (BiV) and LV-only single-site pacing (LVSS), the electrode with the latest sensed RV-LV conduction time was selected as the LV1 cathode. (B) For MultiPoint Pacing (MPP) and LV-only MultiPoint Pacing (LVMPP), the pair of electrodes with the widest spacing were selected as LV1 and LV2 cathodes.

Figure 4. QRS duration reduction across pacing configurations with and without SyncAV. (A) QRS duration and (B) QRS duration reduction relative to intrinsic conduction. Brackets indicate significant differences. BiV, biventricular pacing; LVMPP, left ventricular-only MultiPoint Pacing; LVSS, left ventricular-only single site pacing; MPP, MultiPoint Pacing.

Figure 5. Relative performance of pacing configurations with and without SyncAV. (A) Distribution of pacing modes associated with the narrowest QRS and (B) distribution of directional QRSd change, relative to intrinsic conduction (narrower in green, wider in red, remainder equivalent to intrinsic). Brackets indicate significant differences across likewise comparisons (eg, across settings without SyncAV, across settings with SyncAV, corresponding settings with vs without SyncAV). BiV, biventricular pacing; LVMPP, left ventricular-only MultiPoint Pacing; LVSS, left ventricular-only single-site pacing; MPP, MultiPoint Pacing.

Figure 6. QRS duration reduction across pacing configurations with SyncAV, relative to intrinsic conduction. QRS duration reduction is shown for subgroups categorized by (A) gender and (B) intrinsic QRS duration above or below the population median. Brackets indicate significant differences across corresponding modes. BiV, biventricular pacing; LVMPP, left ventricular-only MultiPoint Pacing; LVSS, left ventricular-only single-site pacing; MPP, MultiPoint Pacing.

Figure 7. QRS duration reduction across pacing configurations with SyncAV, relative to intrinsic conduction. QRS duration reduction is shown for subgroups categorized by (A) RV lead site at septum or apex, (B) LV lead site from base to apex, and (C) LV lead site from antero-lateral to posterolateral. Brackets indicate significant differences across corresponding modes. BiV, biventricular pacing; LVMPP, left ventricular-only MultiPoint Pacing; LV, left ventricular; LVSS, left ventricular-only single site pacing; MPP, MultiPoint Pacing; RV, right ventricular.