Key result
The combination of best quadripolar pacing configuration and AV/VV delay optimization improved cardiac output compared to standard biventricular stimulation in 68% of patients.
Why the study?
Does combining the best quadripolar pacing configuration with AV and VV delay optimization improve cardiac output compared to standard biventricular configuration in patients receiving CRT?
Does combining the best quadripolar pacing configuration with AV and VV delay optimization improve cardiac output compared to standard biventricular configuration in patients receiving CRT?
Absolute Event Rate: 5.56% vs 4.65%
Combining optimal quadripolar pacing configuration with AV and VV delay optimization significantly improves cardiac output compared to standard biventricular pacing, achieving hemodynamic benefits comparable to multipoint pacing.
May augment CRT response; hypothesis-generating and requires randomized outcome trials before practice change.
BACKGROUND: Cardiac resynchronization therapy optimization can be pursued by left ventricular pacing vector selection and atrioventricular (AV) and interventricular (VV) delays optimization. The combination of these methods and its comparison with multipoint pacing (MPP) is scarcely studied. METHODS: Using noninvasive cardiac output (CO) measurement, the best of five left ventricular pacing vectors was determined, then AV and VV delays optimization was applied on top of the best vector. Response to the optimization protocol was defined as a >5% CO increase compared to the standard biventricular configuration. RESULTS: Twenty-two patients (18 men, age 71 ± 9 years) were included. Standard biventricular configuration increased CO compared to baseline (4.65 ± 1.55 L/min vs 4.27 ± 1.53 L/min, respectively, P = 0.02). The best quadripolar configuration increased CO to 4.85 ± 1.67 L/min (P = 0.03 compared to the standard biventricular configuration). AV then VV delay optimization both provided additional benefit (final CO 5.56 ± 2.03 L/min, P = 0.001 compared to the best quadripolar configuration). Fifteen (68%) patients responded to the optimization protocol. Anatomical MPP (based on maximal anatomical separation between electrodes) and electrical MPP (based on maximal electrical activation difference between electrodes) were evaluated in 16 patients and yielded a CO similar to that of the optimization procedure. CONCLUSIONS: The combination of choosing the best quadripolar pacing configuration and optimizing atrioventricular and interventricular delays resulted in an improvement of cardiac output compared to standard biventricular stimulation in 68% of patients. The final cardiac output was comparable to multipoint pacing.
No takes yet. Share an insight, caveat, or question.
Socié et al. (2018) studied Cardiac resynchronization therapy (n=22). Combination of best quadripolar pacing configuration and AV/VV delay optimization vs. Standard biventricular configuration was evaluated on Cardiac output (L/min). The combination of best quadripolar pacing configuration and AV/VV delay optimization improved cardiac output compared to standard biventricular stimulation in 68% of patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: