Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy

Wouter M. van Everdingen, Alwin Zweerink, Odette A.E. Salden, Maarten J. Cramer, Pieter A. Doevendans, Elien B. Engels, Albert C. van Rossum, Frits W. Prinzen, Kevin Vernooy, Cornelis P. Allaart, Mathias Meine

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP. Background: MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy. Methods: Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Δ%SW) compared with baseline measurements during intrinsic conduction. Δ%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Δ%SW (BIV-OPT). Results: Forty-three patients were analyzed (age 66 ± 10 years, 63% men, 30% ischemic cardiomyopathy, LV ejection fraction 29 ± 8%, and QRS duration 175 ± 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 ± 8%, and variation between LV electrodes was 9 ± 5%. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Δ%SW +15 ± 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Δ%SW with MPP compared with BIV-OPT (−5 ± 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Δ%SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis. Conclusions: Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP.

Original languageEnglish
Pages (from-to)881-889
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume4
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018

Cite this

van Everdingen, Wouter M. ; Zweerink, Alwin ; Salden, Odette A.E. ; Cramer, Maarten J. ; Doevendans, Pieter A. ; Engels, Elien B. ; van Rossum, Albert C. ; Prinzen, Frits W. ; Vernooy, Kevin ; Allaart, Cornelis P. ; Meine, Mathias. / Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy. In: JACC: Clinical Electrophysiology. 2018 ; Vol. 4, No. 7. pp. 881-889.
@article{aecede1bcb5a4d2686049b2c99db785f,
title = "Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy",
abstract = "Objectives: This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP. Background: MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy. Methods: Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Δ{\%}SW) compared with baseline measurements during intrinsic conduction. Δ{\%}SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Δ{\%}SW (BIV-OPT). Results: Forty-three patients were analyzed (age 66 ± 10 years, 63{\%} men, 30{\%} ischemic cardiomyopathy, LV ejection fraction 29 ± 8{\%}, and QRS duration 175 ± 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 ± 8{\%}, and variation between LV electrodes was 9 ± 5{\%}. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Δ{\%}SW +15 ± 35{\%}; p < 0.05) with a large interindividual variation. There was no significant difference in Δ{\%}SW with MPP compared with BIV-OPT (−5 ± 24{\%}; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Δ{\%}SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis. Conclusions: Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP.",
keywords = "acute hemodynamic response, cardiac resynchronization therapy, multipoint pacing, pressure-volume loops, quadripolar lead",
author = "{van Everdingen}, {Wouter M.} and Alwin Zweerink and Salden, {Odette A.E.} and Cramer, {Maarten J.} and Doevendans, {Pieter A.} and Engels, {Elien B.} and {van Rossum}, {Albert C.} and Prinzen, {Frits W.} and Kevin Vernooy and Allaart, {Cornelis P.} and Mathias Meine",
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Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy. / van Everdingen, Wouter M.; Zweerink, Alwin; Salden, Odette A.E.; Cramer, Maarten J.; Doevendans, Pieter A.; Engels, Elien B.; van Rossum, Albert C.; Prinzen, Frits W.; Vernooy, Kevin; Allaart, Cornelis P.; Meine, Mathias.

In: JACC: Clinical Electrophysiology, Vol. 4, No. 7, 01.07.2018, p. 881-889.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy

AU - van Everdingen, Wouter M.

AU - Zweerink, Alwin

AU - Salden, Odette A.E.

AU - Cramer, Maarten J.

AU - Doevendans, Pieter A.

AU - Engels, Elien B.

AU - van Rossum, Albert C.

AU - Prinzen, Frits W.

AU - Vernooy, Kevin

AU - Allaart, Cornelis P.

AU - Meine, Mathias

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objectives: This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP. Background: MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy. Methods: Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Δ%SW) compared with baseline measurements during intrinsic conduction. Δ%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Δ%SW (BIV-OPT). Results: Forty-three patients were analyzed (age 66 ± 10 years, 63% men, 30% ischemic cardiomyopathy, LV ejection fraction 29 ± 8%, and QRS duration 175 ± 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 ± 8%, and variation between LV electrodes was 9 ± 5%. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Δ%SW +15 ± 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Δ%SW with MPP compared with BIV-OPT (−5 ± 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Δ%SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis. Conclusions: Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP.

AB - Objectives: This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP. Background: MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy. Methods: Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Δ%SW) compared with baseline measurements during intrinsic conduction. Δ%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Δ%SW (BIV-OPT). Results: Forty-three patients were analyzed (age 66 ± 10 years, 63% men, 30% ischemic cardiomyopathy, LV ejection fraction 29 ± 8%, and QRS duration 175 ± 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 ± 8%, and variation between LV electrodes was 9 ± 5%. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Δ%SW +15 ± 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Δ%SW with MPP compared with BIV-OPT (−5 ± 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Δ%SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis. Conclusions: Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP.

KW - acute hemodynamic response

KW - cardiac resynchronization therapy

KW - multipoint pacing

KW - pressure-volume loops

KW - quadripolar lead

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U2 - 10.1016/j.jacep.2018.02.005

DO - 10.1016/j.jacep.2018.02.005

M3 - Article

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SP - 881

EP - 889

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

SN - 2405-500X

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