Cardiac Arrhythmia Service Center, Fuwai Hospital CAMS & PUMC, Beijing, China.
Department of Cardiology, The Third People's Hospital of Chengdu, Chengdu, China.
Pacing Clin Electrophysiol. 2022 May;45(5):649-657. doi: 10.1111/pace.14485. Epub 2022 Apr 11.
The benefits of cardiac resynchronization therapy (CRT) in heart failure patients have been shown to depend on device programming, particularly atrioventricular delay (AVD) and left ventricular (LV) pacing site selection. This study compared the hemodynamic AVD optimization for commonly used biventricular (BiV) and MultiPoint Pacing(MPP, Abbott) LV vector selection strategies.
After de novo CRT-D (Abbott Quadra Assura MP) and quadripolar LV lead (Abbott Quartet) implant, acute LV pressure was measured across a range of AVDs (60-225 ms) in four pacing modes: BiV with most proximal cathode, BiV with most distal cathode, MPP using two cathodes with earliest and latest right ventricle (RV)-LV activation times, and MPP using two cathodes with maximal anatomical separation. Hemodynamic improvement was evaluated by changes in maximum LV pressure first-derivative versus RV pacing (ΔdP/dt).
Twenty patients (64 years old, 68% male) completed the acute pacing protocol at six centers in China. Hemodynamic improvement versus RV pacing for BiV (proximal), BiV (Distal), MPP (electrical), and MPP (anatomical) was 22.1% ± 13.6%, 23.7% ± 13.4%, 24.5% ± 13.4%, and 25.1% ± 13.9%, respectively. The best MPP setting was marginally superior to the best BiV across all patients (25.8% ± 13.4% vs. 24.5% ± 13.1%, p = .040) and in the majority of patients (75.0% vs. 25.0%, p = .004). AVD programmed as little as 20 ms from optimum significantly reduced the ΔdP/dt benefit for all modes.
The maximal hemodynamic improvement across AV delays in this population was greater with MPP than BiV. Furthermore, patient-specific AVD programming was critical in achieving the full hemodynamic response for all BiV and MPP modes.
心脏再同步治疗（CRT）在心力衰竭患者中的益处取决于设备的程控，特别是房室延迟（AVD）和左心室（LV）起搏部位的选择。本研究比较了常用的双心室（BiV）和多点起搏（MPP， Abbott）LV 向量选择策略的急性血流动力学 AVD 优化。
在新植入 CRT-D（Abbott Quadra Assura MP）和四极 LV 导联（Abbott Quartet）后，在四种起搏模式下测量了一系列 AVD（60-225ms）下的急性 LV 压力：最接近阴极的 BiV、最远离阴极的 BiV、使用最早和最晚右心室（RV）-LV 激活时间的两个阴极的 MPP 以及使用两个阴极的最大解剖分离的 MPP。通过与 RV 起搏相比 LV 压力一阶导数的变化（ΔdP/dt）来评估血流动力学改善。
20 名患者（64 岁，68%男性）在中国的 6 个中心完成了急性起搏方案。与 RV 起搏相比，BiV（近端）、BiV（远端）、MPP（电）和 MPP（解剖）的血流动力学改善分别为 22.1%±13.6%、23.7%±13.4%、24.5%±13.4%和 25.1%±13.9%。在所有患者中，最佳 MPP 设置略优于最佳 BiV（25.8%±13.4%比 24.5%±13.1%，p=0.040），在大多数患者中（75.0%比 25.0%，p=0.004）。AVD 程控为最接近最佳值的 20ms 显著降低了所有模式的ΔdP/dt 获益。
在该人群中，AV 延迟的最大血流动力学改善在 MPP 中大于 BiV。此外，为所有 BiV 和 MPP 模式实现完全血流动力学反应，患者特异性 AVD 程控至关重要。
