Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Bakken Research Centre, Medtronic, Inc., Maastricht, The Netherlands.
Europace. 2016 Aug;18(8):1227-34. doi: 10.1093/europace/euv396. Epub 2015 Dec 30.
The clinical response to cardiac resynchronization therapy (CRT) is variable. Multipoint left ventricular (LV) pacing could achieve more effective haemodynamic response than single-point LV pacing. Deployment of an LV lead over myocardial scar is associated with a poor haemodynamic response to and clinical outcome of CRT. We sought to determine whether the acute haemodynamic response to CRT using three-pole LV multipoint pacing (CRT3P-MPP) is superior to that to conventional CRT using single-site LV pacing (CRTSP) in patients with ischaemic cardiomyopathy and an LV free wall scar.
Sixteen patients with ischaemic cardiomyopathy [aged 72.6 ± 7.7 years (mean ± SD), 81.3% male, QRS: 146.0 ± 14.2 ms, LBBB in 14 (87.5%)] in whom the LV lead was intentionally deployed straddling an LV free wall scar (assessed using cardiac magnetic resonance), underwent assessment of LV + dP/dtmax during CRT3P-MPP and CRTSP. Interindividually, the ΔLV + dP/dtmax in relation to AAI pacing with CRT3P-MPP (6.2 ± 13.3%) was higher than with basal and mid CRTSP (both P < 0.001), but similar to apical CRTSP. Intraindividually, significant differences in the ΔLV + dP/dtmax to optimal and worst pacing configurations were observed in 10 (62.5%) patients. Of the 8 patients who responded to at least one configuration, CRT3P-MPP was optimal in 5 (62.5%) and apical CRTSP was optimal in 3 (37.5%) (P = 0.0047).
In terms of acute haemodynamic response, CRT3P-MPP was comparable an apical CRTSP and superior to basal and distal CRTSP. In the absence of within-device haemodynamic optimization, CRT3P-MPP may offer a haemodynamic advantage over a fixed CRTSP configuration.
心脏再同步治疗（CRT）的临床反应是可变的。多点左心室（LV）起搏比单点 LV 起搏更能实现有效的血液动力学反应。LV 导联在心肌瘢痕上的部署与 CRT 的血液动力学反应和临床结果较差相关。我们试图确定使用三极 LV 多点起搏（CRT3P-MPP）的 CRT 对缺血性心肌病和 LV 游离壁瘢痕患者的急性血液动力学反应是否优于使用单点 LV 起搏（CRTSP）的 CRT。
16 例缺血性心肌病患者[年龄 72.6±7.7 岁（平均值±标准差），81.3%为男性，QRS：146.0±14.2ms，14 例（87.5%）为 LBBB]，LV 导联故意跨越 LV 游离壁瘢痕部署（使用心脏磁共振评估），在 CRT3P-MPP 和 CRTSP 期间评估 LV + dP/dtmax。个体间，与 CRT3P-MPP 下的 AAI 起搏相比，LV + dP/dtmax 的 ΔLV + dP/dtmax（6.2±13.3%）更高（均 P<0.001），但与 CRTSP 下的近心尖部起搏相似。个体内，在 10 例（62.5%）患者中观察到最佳和最差起搏配置的 ΔLV + dP/dtmax 存在显著差异。在对至少一种配置有反应的 8 例患者中，5 例（62.5%）的 CRT3P-MPP 是最佳的，3 例（37.5%）的 CRTSP 近心尖部起搏是最佳的（P=0.0047）。
就急性血液动力学反应而言，CRT3P-MPP 与 CRTSP 近心尖部起搏相当，优于 CRTSP 基底和远心尖部起搏。在没有设备内血液动力学优化的情况下，CRT3P-MPP 可能比固定的 CRTSP 配置具有血液动力学优势。
