Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Cardiology Department, Ospedale Santa Croce e Carle, Cuneo, Italy.
Heart Rhythm. 2015 Aug;12(8):1762-9. doi: 10.1016/j.hrthm.2015.04.029. Epub 2015 Apr 24.
Multipoint left ventricular (LV) pacing (MultiPoint Pacing [MPP], St Jude Medical, Sylmar, CA) in a single coronary sinus branch has been introduced as a novel means of cardiac resynchronization therapy (CRT). It is speculated that MPP improves LV function by capturing a larger LV tissue area, resulting in uniform wavefront propagation throughout the ventricles, in comparison to conventional biventricular pacing (BIV).
The purpose of this study was to evaluate MPP by means of contact mapping and hemodynamic measures to understand the underlying mechanisms and effects.
Ten patients with non-ischemic cardiomyopathy (mean age 69 ± 9 years; 6 men (60%); New York Heart Association heart failure class II or III; QRS duration 173 ± 20 ms; LV ejection fraction 27% ± 5%) received a CRT-defibrillator capable of MPP. After the implantation procedure, an acute pacing protocol was implemented, including 2 BIV and up to 9 MPP interventions. In all pacing interventions, LV electrical activation patterns and hemodynamics (dP/dtmax) were evaluated, and for each patient, both the resulting measures were compared between MPP and BIV interventions.
Compared with BIV, MPP resulted in an increase in LV dP/dtmax (30% ± 13% vs. 25% ± 11%; P = .041), a reduction in QRS duration (22% ± 11% vs. 11% ± 11%; P = .01), and a decrease in total endocardial activation time (25% ± 15% vs. 10% ± 20%; P = .01). MPP resulted in a larger capture of LV mass during the first 25 ms (35% ± 22% vs. 16% ± 8%; P = .005) and during the first 50 ms (78% ± 27% vs. 60% ± 23%; P = .03) of pacing, suggesting a quicker wavefront propagation throughout the left ventricle.
In this acute study, MPP in CRT improved both endocardial and surface electrical parameters and hemodynamics in comparison with BIV.
多点左心室（LV）起搏（多点起搏[MPP]，圣犹达医疗公司，西尔马，加利福尼亚州）在单个冠状窦分支中的应用已被引入作为一种新的心脏再同步治疗（CRT）手段。有人推测，与传统的双心室起搏（BIV）相比，MPP 通过捕获更大的 LV 组织面积来改善 LV 功能，从而导致心室之间的均匀波前传播。
本研究旨在通过接触映射和血流动力学测量来评估 MPP，以了解其潜在机制和效果。
10 例非缺血性心肌病患者（平均年龄 69 ± 9 岁；6 名男性（60%）；纽约心脏协会心力衰竭 II 或 III 级；QRS 持续时间 173 ± 20 ms；LV 射血分数 27% ± 5%）接受了可进行 MPP 的 CRT 除颤器植入。植入手术后，实施了急性起搏方案，包括 2 次 BIV 和多达 9 次 MPP 干预。在所有起搏干预中，评估了 LV 电激活模式和血流动力学（dP/dtmax），并对每位患者的 MPP 和 BIV 干预之间的结果进行了比较。
与 BIV 相比，MPP 导致 LV dP/dtmax 增加（30% ± 13%比 25% ± 11%；P =.041），QRS 持续时间缩短（22% ± 11%比 11% ± 11%；P =.01），以及总心内膜激活时间减少（25% ± 15%比 10% ± 20%；P =.01）。MPP 在起搏的前 25 ms（35% ± 22%比 16% ± 8%；P =.005）和前 50 ms（78% ± 27%比 60% ± 23%；P =.03）期间捕获的 LV 质量更大，这表明波前在整个左心室的传播更快。
在这项急性研究中，与 BIV 相比，CRT 中的 MPP 改善了心内膜和表面电参数以及血流动力学。
