April 7, 2018Journal of Interventional Cardiac ElectrophysiologyOpen Access

Hemodynamic comparison of different multisites and multipoint pacing strategies in cardiac resynchronization therapies

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Why the study?

Does multipoint or multisite pacing acutely improve hemodynamic response and QRS duration compared to standard biventricular pacing in CRT candidates with permanent atrial fibrillation?

Population

15 consecutive adults with permanent atrial fibrillation and indications for cardiac resynchronization…

Comparison

Multipoint pacing through a single quadripolar… vs Baseline intrinsic rhythm and standard…

Design

Cohort

Follow-up

acute

Authors

FZFrancesco ZanonElectrophysiology LMLina MarcantoniOspedale Santa Maria della Misericordia di Rovigo EBEnrico BaraccaOspedale Santa Maria della Misericordia di Rovigo

Discussion

Member takes

Implication

MPP may acutely enhance LV contractility in AF-CRT patients; leaves open effects on clinical outcomes.

Structured PICO

Does multipoint or multisite pacing acutely improve hemodynamic response and QRS duration compared to standard biventricular pacing in CRT candidates with permanent atrial fibrillation?

Population

15 consecutive adults with permanent atrial fibrillation (AF) and indications for cardiac resynchronization therapy (CRT), mean age 76 ± 7 years, 86.7% male, single-center (Italy). Key characteristics: LVEF 33 ± 7%, mean QRS duration 178 ± 25 ms, 46.7% with ischemic cardiomyopathy.

Intervention

Multipoint pacing (MPP) through a single quadripolar lead, triple ventricular pacing (TRIV) by means of two left ventricular (LV) leads, and the combination of TRIV and MPP (MPP + TRIV), evaluated acutely during the implantation procedure.

Comparator

Baseline intrinsic rhythm and standard biventricular pacing (BIV) evaluated acutely in the same patients.

Outcome

Acute hemodynamic response evaluated as the variation in LVdp/dtmax over a 15-second interval using a RADI pressure wire.surrogate

In CRT candidates with permanent atrial fibrillation, multipoint and multisite pacing acutely improve left ventricular contractility and reduce QRS duration more effectively than standard biventricular pacing.

Limitations

Acute, single-center, non-randomized study
Limited patient sample size
Pacing protocol configurations were conditioned by the limitations of currently available technology
Lack of randomization of the protocol might have influenced hemodynamics by introducing linear effects
Acute hemodynamic results may not lead to long-term clinical benefit

Cite This Study

Zanon et al. (2018) studied this question.

synapsesocial.com/papers/6a83444bf41d4f5c6da0f271 https://doi.org/10.1007/s10840-018-0362-y

Topics

Women and heart disease

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Hemodynamic comparison of different multisites and multipoint pacing strategies in cardiac resynchronization therapies

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Hemodynamic comparison of different multisites and multipoint pacing strategies in cardiac resynchronization therapies

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

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Topics

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