Pressure-Volume Loop Analysis of Multipoint Pacing With a Quadripolar Left Ventricular Lead in Cardiac Resynchronization Therapy

OBJECTIVES This study aimed to compare multipoint pacing (MPP) to optimal biventricular pacing with a quadripolar left ventricular (LV) lead and find factors associated with hemodynamic response to MPP. BACKGROUND MPP with a quadripolar LV lead may increase response to cardiac resynchronization therapy. METHODS Heart failure patients with a left bundle branch block underwent cardiac resynchronization therapy implantation. Q to LV sensing interval divided by the intrinsic QRS duration was measured. Invasive pressure-volume loops were assessed during 4 biventricular pacing settings and 3 MPP settings, using 4 atrioventricular delays. Hemodynamic response was defined as change in stroke work (Delta%SW) compared with baseline measurements during intrinsic conduction. Delta%SW of MPP was compared with conventional biventricular pacing using the distal electrode and the electrode with highest Delta%SW (BIV-OPT). RESULTS Forty-three patients were analyzed (age 66 +/- 10 years, 63% men, 30% ischemic cardiomyopathy, LV ejection fraction 29 +/- 8%, and QRS duration 175 +/- 13 ms). Q to local LV sensing interval corrected for QRS duration was 84 +/- 8%, and variation between LV electrodes was 9 +/- 5%. Compared with conventional biventricular pacing using the distal electrode, MPP showed a significant higher increase of SW (Delta%SW +15 +/- 35%; p < 0.05) with a large interindividual variation. There was no significant difference in Delta%SW with MPP compared with BIV-OPT (-5 +/- 24%; p = 0.19). Male sex and low LV ejection fraction were associated with increase in Delta%SW due to MPP versus BIV-OPT in multivariate analysis, while ischemic cardiomyopathy was only associated in univariate analysis. CONCLUSIONS Optimization of the pacing site of a quadripolar LV lead is more important than to program MPP. However, specific subgroups (i.e., especially men) may benefit substantially from MPP. (c) 2018 by the American College of Cardiology Foundation.