Hospital Universitario de Badajoz, Av. de Elvas, s/n, 06080, Badajoz, Spain.
Abbott Medical España, Madrid, Spain.
J Interv Card Electrophysiol. 2020 Apr;57(3):481-487. doi: 10.1007/s10840-020-00720-2. Epub 2020 Mar 6.
Cardiac resynchronization therapy (CRT) with left ventricular (LV) MultiPoint™ pacing (MPP) has been shown to improve CRT response by pacing two LV sites (LV1, LV2). While an additional LV pacing site reduces battery longevity, this cost can be minimized by leveraging an existing device-based capture management algorithm (LVCap™ Confirm). The purpose of this study was to evaluate the MPP battery longevity improvement achieved by configuring LV pacing sites to properly leverage LVCap Confirm.
Patients previously enrolled in the MORE-CRT MPP trial with existing MPP-enabled CRT-D devices (Abbott Quadra Assura MP™ CD3371-40QC, Quartet™ LV lead) underwent device interrogation. Device electrical characteristics and estimated battery longevities were compared for various MPP settings.
At 2.1 ± 1.1 years post-implant, the estimated remaining battery longevity in 65 patients was 70 ± 14 months with MPP Off (LV pacing from minimum capture threshold). Enabling MPP with maximal anatomical separation between LV1 and LV2 cathodes reduced longevity by 15 ± 14%. However, swapping the LV1 and LV2 cathodes, such that the LV1 threshold was the higher of the two, allowed the device to take full advantage of the LVCap™ Confirm capture management algorithm, resulting in significantly lower longevity reduction of 9 ± 11% (p < 0.001). Ultimately, a mean MPP battery longevity improvement of 7.7 ± 10.3% (p < 0.001) was achieved by simply swapping LV1/LV2 configurations.
By properly leveraging device-based capture management features, the impact of MPP on battery longevity can be significantly reduced.
左心室（LV）多点起搏（MPP）的心脏再同步治疗（CRT）已被证明通过起搏两个 LV 部位（LV1、LV2）来改善 CRT 反应。虽然增加一个 LV 起搏部位会降低电池寿命，但通过利用现有的基于设备的捕获管理算法（LVCap™ Confirm），可以最小化这种成本。本研究的目的是评估通过正确配置 LV 起搏部位以充分利用 LVCap Confirm 来实现的 MPP 电池寿命延长。
先前在 MORE-CRT MPP 试验中入组并具有现有 MPP 功能的 CRT-D 设备（雅培 Quadra Assura MP™ CD3371-40QC， Quartet™ LV 导联）的患者进行了设备检测。比较了各种 MPP 设置的设备电气特性和估计电池寿命。
在植入后 2.1±1.1 年，65 例患者的估计剩余电池寿命为 70±14 个月，MPP 关闭（LV 起搏从最小捕获阈值开始）。启用 MPP 时，LV1 和 LV2 阴极之间的最大解剖分离减少了 15±14%的寿命。然而，交换 LV1 和 LV2 阴极，使 LV1 阈值成为两个阈值中的较高值，可以使设备充分利用 LVCap™ Confirm 捕获管理算法，从而使寿命缩短率显著降低 9±11%（p<0.001）。最终，通过简单地交换 LV1/LV2 配置，实现了平均 MPP 电池寿命延长 7.7±10.3%（p<0.001）。
通过正确利用基于设备的捕获管理功能，可以显著降低 MPP 对电池寿命的影响。
