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ACUTE HEMODYNAMIC BENEFITS OF MULTISITE LEFT VENTRICULAR PACING IN CRT RECIPIENTS
E972 JACC March 27, 2012 Volume 59, Issue 13
Heart Failure ACUTE HEMODYNAMIC BENEFITS OF MULTISITE LEFT VENTRICULAR PACING IN CRT RECIPIENTS ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 11:00 a.m.-Noon
Session Title: Biventricular Pacing: Mechanisms and Insights Abstract Category: 13. Heart Failure: Therapy Presentation Number: 1213-71 Authors: C. Aldo Rinaldi, Wolfgang Kranig, Christophe Leclercq, Salem Kacet, Tim Betts, Pierre Bordachar, Klaus Gutleben, Allen Keel, Kyungmoo Ryu, Taraneh G. Farazi, Marcus Simon, Tasneem Naqvi, St. Thomas’ Hospital, London, United Kingdom Background: With the advent of Quartet™ LV lead and multisite LV pacing (MultiPoint™ pacing [MPP]) in CRT, the ability to pace multiple LV sites may provide incremental hemodynamic benefit. The purpose of this study was to characterize the acute hemodynamic effects of MPP compared to conventional BiV pacing (w/ D1) in post-implant CRT patients. Methods: Patients (N=13) undergoing or recently receiving a CRT implant were studied at 7 sites. Each patient underwent an acute pacing protocol comprising BiV simultaneous pacing (BASELINE) and a set of 8 MPP interventions covering a range of LVLV and LVRV delay combinations. Pacing rate was kept constant throughout the protocol. Transthoracic echocardiography was performed during each pacing intervention and analyzed by a core lab. LV outflow velocity time integral (VTI) was computed from pulsed wave Doppler using a mean of 3 consecutive beats. Since the clinical significance of the degree of acute VTI changes is not well established, a series of different thresholds in improvement (10%, 15%, 20%, 25%) was used to demonstrate the benefit of MPP. Results: All patients had at least one MPP intervention that resulted in an increase in VTI, compared to BASELINE. Ten (77%) of the patients exhibited at least one MPP intervention that was ≥10% superior to BASELINE. Conclusion: MPP can provide acute hemodynamic improvement over conventional BiV pacing in CRT patients. Modified MPP settings of LVLV and LVRV delays may be necessary to obtain maximal effect on ventricular hemodynamics.
Heart Failure ACUTE HEMODYNAMIC BENEFITS OF MULTISITE LEFT VENTRICULAR PACING IN CRT RECIPIENTS ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 11:00 a.m.-Noon
Session Title: Biventricular Pacing: Mechanisms and Insights Abstract Category: 13. Heart Failure: Therapy Presentation Number: 1213-71 Authors: C. Aldo Rinaldi, Wolfgang Kranig, Christophe Leclercq, Salem Kacet, Tim Betts, Pierre Bordachar, Klaus Gutleben, Allen Keel, Kyungmoo Ryu, Taraneh G. Farazi, Marcus Simon, Tasneem Naqvi, St. Thomas’ Hospital, London, United Kingdom Background: With the advent of Quartet™ LV lead and multisite LV pacing (MultiPoint™ pacing [MPP]) in CRT, the ability to pace multiple LV sites may provide incremental hemodynamic benefit. The purpose of this study was to characterize the acute hemodynamic effects of MPP compared to conventional BiV pacing (w/ D1) in post-implant CRT patients. Methods: Patients (N=13) undergoing or recently receiving a CRT implant were studied at 7 sites. Each patient underwent an acute pacing protocol comprising BiV simultaneous pacing (BASELINE) and a set of 8 MPP interventions covering a range of LVLV and LVRV delay combinations. Pacing rate was kept constant throughout the protocol. Transthoracic echocardiography was performed during each pacing intervention and analyzed by a core lab. LV outflow velocity time integral (VTI) was computed from pulsed wave Doppler using a mean of 3 consecutive beats. Since the clinical significance of the degree of acute VTI changes is not well established, a series of different thresholds in improvement (10%, 15%, 20%, 25%) was used to demonstrate the benefit of MPP. Results: All patients had at least one MPP intervention that resulted in an increase in VTI, compared to BASELINE. Ten (77%) of the patients exhibited at least one MPP intervention that was ≥10% superior to BASELINE. Conclusion: MPP can provide acute hemodynamic improvement over conventional BiV pacing in CRT patients. Modified MPP settings of LVLV and LVRV delays may be necessary to obtain maximal effect on ventricular hemodynamics.