A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study

TY - JOUR

T1 - A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization

T2 - an acute haemodynamic and electroanatomical study

AU - Shetty, Anoop

AU - Sohal, Manav

AU - Chen, Zhong

AU - Ginks, Matthew

AU - Bostock, Julian

AU - Amraoui, Sana

AU - Ryu, Kyungmoo

AU - Rosenberg, Stuart P.

AU - Niederer, Steven A.

AU - Gill, Jaswinder

AU - Carr-White, Gerald

AU - Razavi, Reza

AU - Rinaldi, Aldo

PY - 2014/6

Y1 - 2014/6

N2 - Aims Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead. Method and results Fifteen patients with a previously implanted CRT system received a second temporary CS lead and left ventricular (LV) endocardial catheter. A pressure wire and non-contact mapping array were placed into the LV cavity to measure LVdP/dt(max) and perform electroanatomical mapping. Conventional CRT, BV-Endo, and MSP were then performed (MSP-1 via two epicardial leads and MSP-2 via a single-quadripolar lead). The best overall AHR was found using BV-Endo pacing with a 19.6 +/- 13.6% increase in AHR at the optimal endocardial site over baseline (P < 0.001). There was an increase in LVdP/dt(max) with MSP-1 and MSP-2 compared with conventional CRT, but this was not statistically significant. Biventricular endocardial pacing from the optimal site was significantly superior to conventional CRT (P = 0.039). The AHR achieved when BV-Endo pacing was highly site specific. Within individuals, the best pacing modality varied and was affected by the underlying substrate. Left ventricular activation times did not predict the optimal haemodynamic configuration. Conclusion Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate.

AB - Aims Alternative forms of cardiac resynchronization therapy (CRT), including biventricular endocardial (BV-Endo) and multisite epicardial pacing (MSP), have been developed to improve response. It is unclear which form of stimulation is optimal. We aimed to compare the acute haemodynamic response (AHR) and electrophysiological effects of BV-Endo with MSP via two separate coronary sinus (CS) leads or a single-quadripolar CS lead. Method and results Fifteen patients with a previously implanted CRT system received a second temporary CS lead and left ventricular (LV) endocardial catheter. A pressure wire and non-contact mapping array were placed into the LV cavity to measure LVdP/dt(max) and perform electroanatomical mapping. Conventional CRT, BV-Endo, and MSP were then performed (MSP-1 via two epicardial leads and MSP-2 via a single-quadripolar lead). The best overall AHR was found using BV-Endo pacing with a 19.6 +/- 13.6% increase in AHR at the optimal endocardial site over baseline (P < 0.001). There was an increase in LVdP/dt(max) with MSP-1 and MSP-2 compared with conventional CRT, but this was not statistically significant. Biventricular endocardial pacing from the optimal site was significantly superior to conventional CRT (P = 0.039). The AHR achieved when BV-Endo pacing was highly site specific. Within individuals, the best pacing modality varied and was affected by the underlying substrate. Left ventricular activation times did not predict the optimal haemodynamic configuration. Conclusion Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate.

KW - Cardiac resynchronization therapy

KW - Multisite pacing

KW - Haemodynamics

KW - Electrophysiology mapping

KW - HEART-FAILURE

KW - PACING SITES

KW - TRIPLE-SITE

KW - THERAPY

KW - LEAD

KW - SCAR

KW - DYSSYNCHRONY

KW - STIMULATION

KW - IMPROVEMENT

KW - ACTIVATION

U2 - 10.1093/europace/eut420

DO - 10.1093/europace/eut420

M3 - Article

SN - 1099-5129

VL - 16

SP - 873

EP - 879

JO - EUROPACE

JF - EUROPACE

IS - 6

ER -