Department of Cardiology, Medical University Graz, Graz, Austria.
Cardiac Department, Niguarda Ca' Granda, Granda Hospital, Milan, Italy.
Heart Rhythm. 2018 Dec;15(12):1766-1774. doi: 10.1016/j.hrthm.2018.06.032. Epub 2018 Jun 22.
Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint Pacing [MPP]) improves acute hemodynamics and chronic outcomes in comparison to conventional biventricular pacing (BiV), though MPP programming questions persist.
In this multicenter feasibility study, we evaluated the feasibility of using noninvasive systolic blood pressure (SBP) to guide MPP programming and assessed the chronic 6-month echocardiographic CRT response.
Patients implanted with MPP-enabled CRT-defibrillator devices underwent noninvasive hemodynamic assessment (finger arterial pressure) during a pacing protocol that included atrial-only pacing and various BiV and MPP configurations. Each configuration was repeated 4 times, alternating with a reference pacing configuration, to calculate the SBP difference relative to reference (ΔSBP). CRT configurations with the greatest ΔSBP were programmed. An independent core laboratory analyzed baseline and 6-month echocardiograms, with CRT response defined as a 6-month reduction in LV end-systolic volume ≥ 15%.
Forty-two patients (71% male; LV ejection fraction 30.3% ± 7.5%; QRS duration 161 ± 19 ms; 26% had ischemic cardiomyopathy) were enrolled in 4 European centers. Relative to atrial-only pacing, the best BiV and best MPP configurations produced significant SBP elevations of 3.1 ± 4.2 (P < .01) and 4.1 ± 4.1 mm Hg (P < .01), respectively (BiV vs MPP; P < .01). Greater SBP elevations were associated with the best MPP compared with the best BiV configurations in 29 of 37 patients completing the pacing protocol (78%). Of MPP-programmed patients completing the 6-month follow-up visit, 23 of 27 (85%) were classified as CRT responders (6-month reduction in LV end-systolic volume 37.0% ± 13.6%).
Acute noninvasive hemodynamics after CRT device implantation predominantly favored MPP over BiV programming. MPP programming guided by noninvasive hemodynamics resulted in positive LV structural remodeling.
与传统双心室起搏（BiV）相比，多点左心室（LV）起搏（多点起搏[MPP]）的心脏再同步治疗（CRT）可改善急性血液动力学和慢性结局，但 MPP 编程问题仍然存在。
在这项多中心可行性研究中，我们评估了使用非侵入性收缩压（SBP）指导 MPP 编程的可行性，并评估了慢性 6 个月 CRT 反应。
接受 MPP 启用的 CRT 除颤器装置植入的患者在起搏方案期间接受非侵入性血液动力学评估（手指动脉压），该方案包括仅心房起搏和各种 BiV 和 MPP 配置。每种配置重复 4 次，与参考起搏配置交替，以计算相对于参考的 SBP 差异（ΔSBP）。编程具有最大ΔSBP 的 CRT 配置。一个独立的核心实验室分析了基线和 6 个月的超声心动图，定义 CRT 反应为 6 个月时 LV 收缩末期容积减少≥15%。
42 名患者（71%为男性；LV 射血分数 30.3%±7.5%；QRS 持续时间 161±19 ms；26%为缺血性心肌病）在 4 个欧洲中心入组。与仅心房起搏相比，最佳 BiV 和最佳 MPP 配置分别产生了 3.1±4.2（P<.01）和 4.1±4.1 mmHg（P<.01）的显著 SBP 升高（BiV 与 MPP；P<.01）。在完成起搏方案的 37 名患者中的 29 名（78%）中，与最佳 BiV 配置相比，较大的 SBP 升高与最佳 MPP 配置相关。在完成 6 个月随访的 MPP 编程患者中，27 名中的 23 名（85%）被归类为 CRT 反应者（6 个月时 LV 收缩末期容积减少 37.0%±13.6%）。
CRT 装置植入后的急性非侵入性血液动力学主要有利于 MPP 编程而非 BiV 编程。由非侵入性血液动力学指导的 MPP 编程导致了 LV 结构重塑的积极变化。
