Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients
Backgound Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics. Objective To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic bene...
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| creator | Pappone, Carlo, MD, PhD Ćalović, Žarko, MD Vicedomini, Gabriele, MD Cuko, Amarild, MD McSpadden, Luke C., PhD Ryu, Kyungmoo, PhD Romano, Enrico, BEng Saviano, Massimo, MD Baldi, Mario, MD Pappone, Alessia, MD Ciaccio, Cristiano, MD Giannelli, Luigi, MD Ionescu, Bogdan, MD Petretta, Andrea, MD Vitale, Raffaele, MD Fundaliotis, Angelica, MD Tavazzi, Luigi, MD Santinelli, Vincenzo, MD |
| description | Backgound Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics. Objective To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients. Methods Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention. Results Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax ; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing −dP/dtmin (−13.5% ± 10.2% vs −10.6% ± 6.8%; P = .011), relaxation time constant (−7.5% ± 9.0% vs −4.8% ± 7.2%; P = .012), and end-diastolic pressure (−18.2% ± 22.4% vs −8.7% ± 21.4%; P < .001) as compared with the best CONV intervention. Conclusions CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV. |
| doi_str_mv | 10.1016/j.hrthm.2013.11.023 |
| format | Article |
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Objective To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients. Methods Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention. Results Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax ; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing −dP/dtmin (−13.5% ± 10.2% vs −10.6% ± 6.8%; P = .011), relaxation time constant (−7.5% ± 9.0% vs −4.8% ± 7.2%; P = .012), and end-diastolic pressure (−18.2% ± 22.4% vs −8.7% ± 21.4%; P < .001) as compared with the best CONV intervention. Conclusions CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2013.11.023</identifier><identifier>PMID: 24291411</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Cardiac Pacing, Artificial - methods ; Cardiac resynchronization therapy ; Cardiovascular ; Female ; Heart failure ; Heart Failure - physiopathology ; Heart Failure - therapy ; Heart Ventricles ; Hemodynamics ; Humans ; Male ; MultiPoint Pacing ; Pacemaker, Artificial ; Pressure-volume loops ; Treatment Outcome</subject><ispartof>Heart rhythm, 2014-03, Vol.11 (3), p.394-401</ispartof><rights>Heart Rhythm Society</rights><rights>2014 Heart Rhythm Society</rights><rights>Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-53516577d0ecf818ac2f8c858c4b0e4a7c9f4a38aa6c4b6a8a500e7bdf487fea3</citedby><cites>FETCH-LOGICAL-c414t-53516577d0ecf818ac2f8c858c4b0e4a7c9f4a38aa6c4b6a8a500e7bdf487fea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527113013805$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24291411$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pappone, Carlo, MD, PhD</creatorcontrib><creatorcontrib>Ćalović, Žarko, MD</creatorcontrib><creatorcontrib>Vicedomini, Gabriele, MD</creatorcontrib><creatorcontrib>Cuko, Amarild, MD</creatorcontrib><creatorcontrib>McSpadden, Luke C., PhD</creatorcontrib><creatorcontrib>Ryu, Kyungmoo, PhD</creatorcontrib><creatorcontrib>Romano, Enrico, BEng</creatorcontrib><creatorcontrib>Saviano, Massimo, MD</creatorcontrib><creatorcontrib>Baldi, Mario, MD</creatorcontrib><creatorcontrib>Pappone, Alessia, MD</creatorcontrib><creatorcontrib>Ciaccio, Cristiano, MD</creatorcontrib><creatorcontrib>Giannelli, Luigi, MD</creatorcontrib><creatorcontrib>Ionescu, Bogdan, MD</creatorcontrib><creatorcontrib>Petretta, Andrea, MD</creatorcontrib><creatorcontrib>Vitale, Raffaele, MD</creatorcontrib><creatorcontrib>Fundaliotis, Angelica, MD</creatorcontrib><creatorcontrib>Tavazzi, Luigi, MD</creatorcontrib><creatorcontrib>Santinelli, Vincenzo, MD</creatorcontrib><title>Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Backgound Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics. Objective To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients. Methods Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention. Results Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax ; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing −dP/dtmin (−13.5% ± 10.2% vs −10.6% ± 6.8%; P = .011), relaxation time constant (−7.5% ± 9.0% vs −4.8% ± 7.2%; P = .012), and end-diastolic pressure (−18.2% ± 22.4% vs −8.7% ± 21.4%; P < .001) as compared with the best CONV intervention. Conclusions CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV.</description><subject>Aged</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiac resynchronization therapy</subject><subject>Cardiovascular</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Failure - therapy</subject><subject>Heart Ventricles</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Male</subject><subject>MultiPoint Pacing</subject><subject>Pacemaker, Artificial</subject><subject>Pressure-volume loops</subject><subject>Treatment Outcome</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsuO1TAMrRCIecAXIKEs2bTETR-5C5DQCBikQSyAdeSbujSXNilJekflS_hc0rkDCzZIlmJZ5_jEPs6yZ8AL4NC8PBSDj8NUlBxEAVDwUjzIzqGum1zIFh5uedXmddnCWXYRwoHzctdw8Tg7K6tyBxXAefbr4zJGMztjIxupj-xINnqjlxE9m1Eb-42ZafbuSIGhXiKxgSbXrRYno5mnMDsbiGEIlKJjtyYObE71sHjKj25cJmKjc3NgxjKNvjN4x1utHryz5idG4yyLA3mc16QZTfpCeJI96nEM9PT-vcy-vnv75eo6v_n0_sPVm5tcV1DFvBY1NHXbdpx0L0GiLnupZS11tedUYat3fYVCIjap0qDEmnNq911fybYnFJfZi1PfNOOPhUJUkwmaxhEtuSUoqDnIJCKqBBUnqPYuBE-9mr2Z0K8KuNosUQd1Z4naLFEAKlmSWM_vBZb9RN1fzh8PEuDVCUBpzKMhr4JOK9DUGU86qs6Z_wi8_oevR2ONxvE7rRQObvE2bVCBCqXi6vN2FdtRgEhNJK_Fb2pduQA</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Pappone, Carlo, MD, PhD</creator><creator>Ćalović, Žarko, MD</creator><creator>Vicedomini, Gabriele, MD</creator><creator>Cuko, Amarild, MD</creator><creator>McSpadden, Luke C., PhD</creator><creator>Ryu, Kyungmoo, PhD</creator><creator>Romano, Enrico, BEng</creator><creator>Saviano, Massimo, MD</creator><creator>Baldi, Mario, MD</creator><creator>Pappone, Alessia, MD</creator><creator>Ciaccio, Cristiano, MD</creator><creator>Giannelli, Luigi, MD</creator><creator>Ionescu, Bogdan, MD</creator><creator>Petretta, Andrea, MD</creator><creator>Vitale, Raffaele, MD</creator><creator>Fundaliotis, Angelica, MD</creator><creator>Tavazzi, Luigi, MD</creator><creator>Santinelli, Vincenzo, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients</title><author>Pappone, Carlo, MD, PhD ; Ćalović, Žarko, MD ; Vicedomini, Gabriele, MD ; Cuko, Amarild, MD ; McSpadden, Luke C., PhD ; Ryu, Kyungmoo, PhD ; Romano, Enrico, BEng ; Saviano, Massimo, MD ; Baldi, Mario, MD ; Pappone, Alessia, MD ; Ciaccio, Cristiano, MD ; Giannelli, Luigi, MD ; Ionescu, Bogdan, MD ; Petretta, Andrea, MD ; Vitale, Raffaele, MD ; Fundaliotis, Angelica, MD ; Tavazzi, Luigi, MD ; Santinelli, Vincenzo, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-53516577d0ecf818ac2f8c858c4b0e4a7c9f4a38aa6c4b6a8a500e7bdf487fea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiac resynchronization therapy</topic><topic>Cardiovascular</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Failure - therapy</topic><topic>Heart Ventricles</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Male</topic><topic>MultiPoint Pacing</topic><topic>Pacemaker, Artificial</topic><topic>Pressure-volume loops</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pappone, Carlo, MD, PhD</creatorcontrib><creatorcontrib>Ćalović, Žarko, MD</creatorcontrib><creatorcontrib>Vicedomini, Gabriele, MD</creatorcontrib><creatorcontrib>Cuko, Amarild, MD</creatorcontrib><creatorcontrib>McSpadden, Luke C., PhD</creatorcontrib><creatorcontrib>Ryu, Kyungmoo, PhD</creatorcontrib><creatorcontrib>Romano, Enrico, BEng</creatorcontrib><creatorcontrib>Saviano, Massimo, MD</creatorcontrib><creatorcontrib>Baldi, Mario, MD</creatorcontrib><creatorcontrib>Pappone, Alessia, MD</creatorcontrib><creatorcontrib>Ciaccio, Cristiano, MD</creatorcontrib><creatorcontrib>Giannelli, Luigi, MD</creatorcontrib><creatorcontrib>Ionescu, Bogdan, MD</creatorcontrib><creatorcontrib>Petretta, Andrea, MD</creatorcontrib><creatorcontrib>Vitale, Raffaele, MD</creatorcontrib><creatorcontrib>Fundaliotis, Angelica, MD</creatorcontrib><creatorcontrib>Tavazzi, Luigi, MD</creatorcontrib><creatorcontrib>Santinelli, Vincenzo, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pappone, Carlo, MD, PhD</au><au>Ćalović, Žarko, MD</au><au>Vicedomini, Gabriele, MD</au><au>Cuko, Amarild, MD</au><au>McSpadden, Luke C., PhD</au><au>Ryu, Kyungmoo, PhD</au><au>Romano, Enrico, BEng</au><au>Saviano, Massimo, MD</au><au>Baldi, Mario, MD</au><au>Pappone, Alessia, MD</au><au>Ciaccio, Cristiano, MD</au><au>Giannelli, Luigi, MD</au><au>Ionescu, Bogdan, MD</au><au>Petretta, Andrea, MD</au><au>Vitale, Raffaele, MD</au><au>Fundaliotis, Angelica, MD</au><au>Tavazzi, Luigi, MD</au><au>Santinelli, Vincenzo, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>11</volume><issue>3</issue><spage>394</spage><epage>401</epage><pages>394-401</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Backgound Conventional cardiac resynchronization therapy (CRT) improves acute cardiac hemodynamics. Objective To investigate if CRT with multipoint left ventricular (LV) pacing in a single coronary sinus branch (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) can offer further hemodynamic benefits to patients. Methods Forty-four consecutive patients (80% men, New York Heart Association III, end-systolic volume 180 ± 77 mL, ejection fraction 27% ± 6%, and QRS duration 152 ± 17 ms) receiving a CRT device implant (Unify Quadra MP or Quadra Assura MP and Quartet LV lead, St Jude Medical) underwent intraoperative assessment of LV hemodynamics by using a pressure-volume loop system (Inca, CD Leycom). A pacing protocol was performed, including 9 biventricular pacing interventions with conventional CRT (CONV) using distal and proximal LV electrodes and various MPP configurations. Each pacing intervention was performed twice in randomized order with right ventricular pacing (BASELINE) repeated after every intervention. Results Evaluable recordings were obtained in 42 patients. Relative to BASELINE, the best MPP intervention significantly increased the rate of pressure change (dP/dtmax ; 15.9% ± 10.0% vs 13.5% ± 8.8%; P < .001), stroke work (27.2% ± 42.5% vs 19.4% ± 32.2%; P = .018), stroke volume (10.4% ± 22.5% vs 4.1% ± 13.1%; P = .003), and ejection fraction (10.5% ± 20.9% vs 5.3% ± 13.2%; P = .003) as compared with the best CONV intervention. Moreover, the best MPP intervention improved acute diastolic function, significantly decreasing −dP/dtmin (−13.5% ± 10.2% vs −10.6% ± 6.8%; P = .011), relaxation time constant (−7.5% ± 9.0% vs −4.8% ± 7.2%; P = .012), and end-diastolic pressure (−18.2% ± 22.4% vs −8.7% ± 21.4%; P < .001) as compared with the best CONV intervention. Conclusions CRT with MPP can significantly improve acute LV hemodynamic parameters assessed with pressure-volume loop measurements as compared with CONV.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24291411</pmid><doi>10.1016/j.hrthm.2013.11.023</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Cardiac Pacing, Artificial - methods Cardiac resynchronization therapy Cardiovascular Female Heart failure Heart Failure - physiopathology Heart Failure - therapy Heart Ventricles Hemodynamics Humans Male MultiPoint Pacing Pacemaker, Artificial Pressure-volume loops Treatment Outcome |
| title | Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients |
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