Key result
Pseudo-MPP using intentional anodal capture was feasible in 80% of CRT patients, with comparable energy consumption to conventional MPP (20,528 vs 18,428 µC, p=0.15).
Why the study?
Up to 40% of patients do not respond to CRT, motivating the evaluation of intentional anodal capture using a single quadripolar LV lead to reproduce multisite pacing without specific algorithms.
Does intentional anodal capture ('pseudo MPP') provide a feasible alternative to conventional multipoint pacing with comparable energy consumption in CRT patients?
Observational (n=15)
No
Does intentional anodal capture ('pseudo MPP') provide a feasible alternative to conventional multipoint pacing with comparable energy consumption in CRT patients?
Pseudo-MPP using intentional anodal capture is feasible in most CRT patients and has comparable energy consumption to conventional multipoint pacing.
Supports pseudo-MPP feasibility in CRT with comparable energy; leaves open clinical utility and outcomes versus standard pacing.
Background: Up to 40% of patients are CRT non-responders. Multisite pacing, using a unique quadripolar lead, also called multipoint/multipole pacing (MPP), is a potential alternative. We sought to determine the feasibility of intentional anodal capture using a single LV quadripolar lead, to reproduce MPP without the need of a specific algorithm (so-called “pseudo MPP”). Methods: Consecutive patients implanted with a commercially available CRT device and a quadripolar LV lead in our department were prospectively included. The electric charge (Q, in Coulomb) of RV and LV pacing spikes were calculated for all available LV pacing configurations at the threshold. The best MPP was defined as the configuration with the lowest consumption (QRV + Qbest LV1 + Qbest LV2). The best “pseudo MPP” (QRV + QLV1–LV2 with anodal capture) and best BVp (QRV + Qbest LV) were also calculated. A theoretical longevity was estimated for each configuration at the threshold without a safety margin. Results: A total of 235 configurations were tested in 15 consecutive patients. “Pseudo-MPP” was feasible in 80% of patients with 3.1 ± 2.6 vectors available per-patient and LVproximal-LVdistal (most distant electrodes) vectors were available in 47% of patients. Each MPP pacing spike electrical charge was comparable to “pseudo-MPP” (18,428 ± 6863 µC and 20,528 ± 5509 µC, respectively, p = 0.15). Theoretical longevity was 6.2 years for MPP, 5.6 years for “pseudo-MPP” and 13.7 years for BVp. Conclusions: “Pseudo MPP” using intentional anodal capture with a quadripolar left ventricular lead, mimicking conventional multisite pacing, is feasible in most of CRT patients, with comparable energy consumption. Further studies on their potential clinical impact are needed.
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Bodin et al. (2021) conducted an observational in Patients requiring cardiac resynchronization therapy (CRT) (n=15). Pseudo-MPP (intentional anodal capture) vs. Conventional multipoint pacing (MPP) was evaluated on Electrical charge of pacing spikes (p=0.15). Pseudo-MPP using intentional anodal capture was feasible in 80% of CRT patients, with comparable energy consumption to conventional MPP (20,528 vs 18,428 µC, p=0.15).
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