Acute Effects of Multisite Left Ventricular Pacing on Mechanical Dyssynchrony in Patients Receiving Cardiac Resynchronization Therapy

作者：Rinaldi C Aldo^*; Kranig Wolfgang; Leclercq Christophe; Kacet Salem; Betts Tim; Bordachar Pierre; Gutleben Klaus Juergen; Shetty Anoop; Keel Allen; Ryu Kyungmoo; Farazi Taraneh G; Simon Marcus; Naqvi Tasneem Z

来源：Journal of Cardiac Failure, 2013, 19(11): 731-738.

DOI：10.1016/j.cardfail.2013.10.003

• Cardiac resynchronization therapy
• biventricular pacing
• multisite pacing
• left ventricular pacing leads
• heart failure
• dyssynchrony

Background: A novel quadripolar left ventricular (LV) pacing lead has the ability to deliver multisite LV pacing (MSLV). We set out to characterize the safety and changes in acute mechanical dyssynchrony with MSLV in cardiac resynchronization therapy (CRT) patients. Methods and Results: Prospective multicenter study in 52 patients receiving CRT. An acute pacing protocol comprising 8 MSLV configurations covering a range of delays was compared with conventional CRT (baseline). Transthoracic tissue Doppler imaging (TDI) was used to measure the standard deviation of time to peak contraction of 12 LV segments (Ts-SD) and delayed longitudinal contraction. No ventricular arrhythmia occurred in any of the 52 patients. Complete TDI datasets were collected in 41 patients. Compared with baseline: 1) The mean Ts-SD was significantly lower for the optimal MSLV configuration (35.3 +/- 36.4 vs 50.2 +/- 29.1 ms; P <.001); 2) at least 1 MSLV configuration exhibited a significant dyssynchrony improvement in 63% of patients; and 3) the mean number of LV segments with delayed longitudinal contractions was significantly reduced with the optimal MSLV configuration (0.37 +/- 7.99 vs 2.20 +/- 0.19; P <.001). Conclusions: Acute MSLV was acutely safe, and a proportion of MSLV vectors resulted in a significant reduction in echocardiographic dyssynchrony compared with conventional CRT.

• 出版日期2013-11