Chudzik M. 1, Waszczykowska J. 2, Urbanek B. 1, Nowek A. 1, Wranicz J. 1
1Department of Electrocardiology, Medical University of Lodz, Poland; 2Foundation Kardiorytm, Lodz, Poland;
Background: Multi-site LV pacing (MSP) is proposed as an alternative to conventional single-site LV pacing in CRT. Response to cardiac resynchronization therapy (CRT) remains challenging. Pacing from multiple sites of the left ventricle (LV) has shown promising results with avoidance of phrenic nerve stimulation and increasing hemodynamic response and decreasing in number of non-responders. Purpose: The purpose of this lecture was to systematically preview and compare advantages in hemodynamic effects of multipoint pacing (MPP) by means of a quadripolar lead to conventional biventricular (BiV) pacing. Methods and results: MultiPoint ™ pacing delivers two pulses from the Quartet ™ LV lead per pacing cycle, resulting in a more uniform ventricular contraction what leads to: capture a larger area of the myocardium, prove transventricular activation time, improve hemodynamic. Many published studies prove superiority of dual pacing comparing to standard LV pacing in hemodynamic parameters as well as in acute response and long term follow up. Multisite LV pacing can improve LV reverse remodeling and cardiac function as characterized by echocardiography, and may result in a higher rate of response to CRT than with single site pacing. MPP can reduce mechanical dyssynchrony above and beyond conventional BiV pacing in up to 67% pts CRT patients, can provide acute hemodynamic improvement over conventional BiV pacing in CRT patients improvement in 77 % of pts, Multisite LV pacing can improve LV reverse remodeling and cardiac function as characterized by echocardiography, and may result in a higher rate of response to CRT – up to 89 % responders with MPP vs 73 % responders with single site pacing and provides in 67% of pts with ≥ 20% reduction in dyssynchrony. MSP lead allows also stable position in the best hemodynamic of the heart area according to ESC guidelines. Phrenic nerve stimulation is observed either during implantation or follow up in up to 22% of the patients what significantly leads to ineffective LV pacing. Possibility to avoid PNS with electrical repositioning of the LV QUARTET lead is the huge step for decreasing the risk of PNS with better CRT effectiveness. Conclusions: MultiPoint Pacing is COMPLEX system for CRT patients with better hemodynamic response and avoiding PNS decreasing number of non-responders.
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