Thibault Bernard, Waddingham Peter, Badie Nima, Mangual Jan O, McSpadden Luke C, Betts Tim R, Calò Leonardo, Grieco Domenico, Leyva Francisco, Chow Anthony
Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
Barts Heart Centre, St Bartholomew's Hospital, London, UK.
CJC Open. 2024 Nov 8;7(2):166-175. doi: 10.1016/j.cjco.2024.11.003. eCollection 2025 Feb.
Cardiac resynchronization therapy (CRT) response relies on 2 factors: when and where to pace. These factors may be enhanced by dynamic atrioventricular delays (AVDs) (eg, SyncAV CRT, Abbott Cardiovascular, Abbott Park, IL) and multisite left ventricular (LV) pacing (eg, MultiPoint Pacing [MPP], Abbott). Their individual and combined synchronization contributions have not been evaluated across a comprehensive spectrum of pacing configurations. The objective is to distinguish the acute electrical synchrony achieved by static vs dynamic AVDs, single-site vs multisite LV pacing, and with vs without right ventricular (RV) pacing.
CRT-indicated patients with left bundle branch block (LBBB) and intact atrioventricular (AV) conduction (PR < 250 ms) were enrolled and evaluated during implant. Acute changes in 12-lead electrocardiographic (ECG) QRS duration (QRSd) were evaluated during intrinsic conduction, biventricular pacing (BiV), biventricular MPP, LV-only single-site pacing (LVSS), and LV-only MPP (LVMPP). CRT modes were evaluated with static AVDs and optimized SyncAV AVDs.
CRT implant and QRSd evaluation were completed in 85 patients (71% male, 34% ischemic, 179 ms PR). The median intrinsic QRSd of 165 ms was reduced by BiV, MPP, LVSS, and LVMPP without SyncAV to 144 ms (by 14%), 142 ms (16%), 155 ms (8%), and 149 ms (12%), respectively ( < 0.01 vs intrinsic). BiV + SyncAV, MPP + SyncAV, LVSS + SyncAV, and LVMPP + SyncAV reduced the intrinsic QRSd significantly further to 128 ms (by 23%), 124 ms (26%), 131 ms (21%), and 129 ms (24%) ( < 0.0001, each corresponding pair).
MPP combined with SyncAV achieved the narrowest QRSd, in the overall population and in the most patients, by delivering ventricular pacing from all available sites (RV + LV1 + LV2) while timed with dynamic AVDs.
NCT03567096.
心脏再同步治疗（CRT）的反应取决于两个因素：起搏的时机和部位。动态房室延迟（AVD）（如SyncAV CRT，雅培心血管公司，伊利诺伊州雅培公园）和多部位左心室（LV）起搏（如多点起搏[MPP]，雅培）可能会增强这些因素。尚未在全面的起搏配置范围内评估它们各自和联合的同步作用。目的是区分静态与动态AVD、单部位与多部位LV起搏以及有与无右心室（RV）起搏所实现的急性电同步。
纳入有CRT指征、左束支传导阻滞（LBBB）且房室（AV）传导完整（PR<250 ms）的患者，并在植入过程中进行评估。在自身传导、双心室起搏（BiV）、双心室MPP、仅左心室单部位起搏（LVSS）和仅左心室MPP（LVMPP）期间评估12导联心电图（ECG）QRS波时限（QRSd）的急性变化。采用静态AVD和优化的SyncAV AVD评估CRT模式。
85例患者完成了CRT植入和QRSd评估（71%为男性，34%为缺血性心脏病，PR为179 ms）。在未使用SyncAV时，BiV、MPP、LVSS和LVMPP分别将中位数为165 ms的自身QRSd降低至144 ms（降低14%）、142 ms（16%）、155 ms（8%）和149 ms（12%）（与自身相比，<0.01）。BiV + SyncAV、MPP + SyncAV、LVSS + SyncAV和LVMPP + SyncAV进一步显著降低自身QRSd至128 ms（降低23%）、124 ms（26%）、131 ms（21%）和129 ms（24%）（每组对应配对，<0.0001）。
MPP联合SyncAV通过在所有可用部位（RV + LV1 + LV2）进行心室起搏并结合动态AVD，在总体人群和大多数患者中实现了最窄的QRSd。
NCT03567096。
