The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results

Autores de IIS La Fe

• Joaquín Osca Asensi

  Autor

• Pau Alonso Fernández

  Autor

• Óscar Cano Pérez

  Autor

• Ana Andrés Lahuerta

  Autor

• Vicente Miró Palau

  Autor

• María José Sancho-Tello De Carranza

  Autor

• Jose Olague De Ros

  Autor

• 

  Luis Vicente Martínez Dolz

  Autor

• Antonio Salvador Sanz

  Autor

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

• Regeneración y Trasplante Cardíaco

Abstract

The objective of the present study was to evaluate the effect of multipoint pacing (MPP) on acute haemodynamics, cardiac contractility, and left ventricle (LV) dyssynchrony, in comparison with conventional cardiac resynchronization therapy (CRT). An open-label, non-randomized, single-centre, prospective study was designed. Twenty-seven consecutive patients were included. Evaluation of pacing configurations was performed in a random order. Transthoracic echocardiography was used to obtain haemodynamic and dyssynchrony parameters. Left ventricular ejection fraction (LVEF) was significantly superior in MPP compared with baseline (38.4 +/- 1.8% vs. 26.1 +/- 2.2%; P < 0.001), and in conventional pacing configuration compared with baseline (33.2 +/- 1.8% vs. 26.1 +/- 2.2%; P = 0.007). Cardiac index (CI) was increased by 21.8 +/- 5.4% and 34.7 +/- 5.1% in conventional and MPP configurations, respectively (P = 0.19). Percentage of acute responders (CI increase a parts per thousand yen10%) was 62.9 and 85.2% in conventional and MPP, respectively (P < 0.001). LV dyssynchrony was defined by radial strain rate parameters. Baseline anteroseptal-to-posterior wall time delay was 168 +/- 21 ms. It was reduced until 70.4 +/- 29 ms in conventional and -6.6 +/- 11 ms in MPP (conventional vs. baseline P = 0.04; MPP vs. conventional P = 0.05). Standard deviation of the time-to-peak radial strain of the 6 LV basal segments was 101 +/- 9.7, 80.3 +/- 9.2, and 66 +/- 8.03 ms in baseline, conventional, and MPP configurations, respectively (MPP vs. basal P = 0.012). Finally, we observed a positive correlation (r = 0.69) between reduction in dyssynchrony and CI increase (P < 0.0001). MPP showed a further reduction in LV dyssynchrony compared with conventional biventricular pacing. Moreover, MPP resulted in an additional improvement in LVEF and in CI, and this was translated into a higher number of acute responders to CRT.

Keywords

• Cardiac resynchronization; Multisite pacing; Dyssynchrony; Speckle tracking echocardiography