Why the study?
Optimization of cardiac resynchronization therapy is often time-consuming and underused clinically, prompting examination of whether novel device-based dynamic AVD and multipoint pacing algorithms improve acute electrical synchrony.
Does the combination of multipoint pacing and patient-specific optimized dynamic atrioventricular delay improve acute electrical synchrony in patients with CRT devices compared to standard pacing configurations?
Does the combination of multipoint pacing and patient-specific optimized dynamic atrioventricular delay improve acute electrical synchrony in patients with CRT devices compared to standard pacing configurations?
Combining multipoint pacing with patient-tailored dynamic atrioventricular delay optimization acutely improves electrical synchrony (QRS duration) more than standard biventricular pacing in CRT patients.
Should not yet change CRT programming; leaves open whether optimized MPP-SyncAV improves clinical outcomes.
Background Optimization of cardiac resynchronization therapy (CRT) is often time‐consuming and therefore underused in a clinical setting. Novel device‐based algorithms aiming to simplify optimization include a dynamic atrioventricular delay (AVD) algorithm (SyncAV, Abbott) and multipoint pacing (MPP, Abbott). This study examines the acute effect of SyncAV and MPP on electrical synchrony in patients with newly and chronically implanted CRT devices. Methods Patients with SyncAV and MPP enabled devices were prospectively enrolled during implant or scheduled follow‐up. Blinded 12‐lead electrocardiographic acute measurements of QRS duration (QRSd) were performed for intrinsic QRSd (Intrinsic), bi‐ventricular pacing (BiV), MPP, BiV with SyncAV at default offset 50 ms (BiVSyncAV def ), BiV with SyncAV at patient‐specific optimised offset (BiVSyncAV opt ), MPP with SyncAV at default offset 50 ms (MPPSyncAV def ), and MPP with SyncAV at patient‐specific optimised offset (MPPSyncAV opt ). Results Thirty‐three patients were enrolled. QRSd for Intrinsic, BiV, MPP, BiVSyncAV def , BiVSyncAV opt , MPPSyncAV def , MPPSyncAV opt were 160.4 ± 20.6 ms, 141.0 ± 20.5 ms, 130.2 ± 17.2 ms, 121.7 ± 20.9 ms, 117.0 ± 19.0 ms, 121.2 ± 17.1 ms, 108.7 ± 16.5 ms respectively. MPPSyncAV opt led to greatest reduction of QRSd relative to Intrinsic (−31.6 ± 11.1%; p < .001), showed significantly shorter QRSd compared to all other pacing configurations ( p < .001) and shortest QRSd in every patient. Shortening of QRSd was not significantly different between newly and chronically implanted devices (−51.6 ± 14.7 ms vs. −52.7 ± 21.9 ms; p = .99). Conclusion SyncAV and MPP improved acute electrical synchrony in CRT. Combining both technologies with patient‐specific optimization resulted in greatest improvement, regardless of time since implantation. Whats new Novel device‐based algorithms like a dynamic AVD algorithm (SyncAV, Abbott) and multipoint pacing (MPP, Abbott) aim to simplify CRT optimization. Our data show that a combination of patient tailored SyncAV optimization and MPP results in greatest improvement of electrical synchrony in CRT measured by QRS duration, regardless if programmed in newly or chronically implanted devices. This is the first study to our knowledge to examine a combination of these device‐based algorithms. The results help understanding the ideal ventricular excitation in heart failure.
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Schiedat et al. (2021) studied this question.
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