Jackson Tom, Lenarczyk Radoslaw, Sterlinski Maciej, Sokal Adam, Francis Darrell, Whinnett Zachary, Van Heuverswyn Frederic, Vanderheyden Marc, Heynens Joeri, Stegemann Berthold, Cornelussen Richard, Rinaldi Christopher Aldo
Department of Cardiology, Guy's & St. Thomas' Hospitals & King's College London, London, United Kingdom.
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland.
Int J Cardiol Heart Vasc. 2018 Apr 10;19:14-19. doi: 10.1016/j.ijcha.2018.03.006. eCollection 2018 Jun.
We sought to determine whether presence, amount and distribution of scar impacts the degree of acute hemodynamic response (AHR) with multisite pacing.Multi-vein pacing (MVP) or multipolar pacing (MPP) with a multi-electrode left ventricular (LV) lead may offer benefits over conventional biventricular pacing in patients with myocardial scar.
In this multi-center study left bundle branch block patients underwent an hemodynamic pacing study measuring LV dP/dt. Patients had cardiac magnetic resonance scar imaging to assess the effect of scar presence, amount and distribution on AHR.
24 patients (QRS 171 ± 20 ms) completed the study (83% male). An ischemic etiology was present in 58% and the mean scar volume was 6.0 ± 7.0%. Overall discounting scar, MPP and MVP showed no significant AHR increase compared to an optimized "best BiV" (BestBiV) site. In a minority of patients (6/24) receiver-operator characteristic analysis of scar volume (cut off 8.48%) predicted a small AHR improvement with MPP (sensitivity 83%, specificity 94%) but not MVP. Patients with scar volume > 8.48% had a MPP-BestBiV of 3 ± 6.3% vs. -6.4 ± 7.7% for those below the cutoff. There was a significant correlation between the difference in AHR and scar volume for MPP-BestBiV (R = 0.49, p = 0.02) but not MVP-BestBiV(R = 0.111, p = 0.62). The multielectrode lead positioned in scar predicted MPP AHR improvement (p = 0.04).
Multisite pacing with MPP and MVP shows no AHR benefit in all-comers compared to optimized BestBiV pacing. There was a minority of patients with significant scar volume in relation to the LV site that exhibited a small AHR improvement with MPP.(Study identifier NCT01883141).
我们试图确定瘢痕的存在、数量和分布是否会影响多部位起搏时的急性血流动力学反应（AHR）程度。对于存在心肌瘢痕的患者，使用多电极左心室（LV）导线进行多静脉起搏（MVP）或多极起搏（MPP）可能比传统双心室起搏更具优势。
在这项多中心研究中，左束支传导阻滞患者接受了一项测量LV dP/dt的血流动力学起搏研究。患者进行了心脏磁共振瘢痕成像，以评估瘢痕的存在、数量和分布对AHR的影响。
24例患者（QRS 171±20 ms）完成了研究（83%为男性）。58%存在缺血性病因，平均瘢痕体积为6.0±7.0%。总体而言，不考虑瘢痕因素，与优化的“最佳双心室”（BestBiV）部位相比，MPP和MVP的AHR没有显著增加。在少数患者（6/24）中，瘢痕体积的受试者工作特征分析（截断值为8.48%）预测MPP可使AHR有小幅改善（敏感性83%，特异性94%），但MVP不能。瘢痕体积>8.48%的患者，MPP与BestBiV相比为3±6.3%，而低于截断值的患者为-6.4±7.7%。MPP与BestBiV相比，AHR差异与瘢痕体积之间存在显著相关性（R=0.49，p=0.02），而MVP与BestBiV之间无相关性（R=0.111，p=0.62）。置于瘢痕中的多电极导线可预测MPP的AHR改善（p=0.04）。
与优化的BestBiV起搏相比，MPP和MVP进行的多部位起搏在所有患者中未显示出AHR优势。少数患者的瘢痕体积相对于LV部位较大，MPP可使AHR有小幅改善。（研究标识符NCT01883141）
