Acute Hemodynamic Effects of Simultaneous and Sequential Multi-Point Pacing in Heart Failure Patients With an Expected Higher Rate of Sub-response to Cardiac Resynchronization Therapy: Results of Multicenter SYNSEQ Study


The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP syn) or sequential (3P-MPP seq) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS ≤ 150 or the absence of LBBB (age: 66 ± 12 years, QRS: 159 ± 12 ms, NYHA class II/III, LVEF ≤ 35%) underwent acute hemodynamic assessment by LV + dP/dtmax with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt max (%ΔLV + dP/dt max) with 3P-MPP syn (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP seq (11.8%, 95% CI: 7.6-16.0%) nor to SPP basal (11.5%, 95% CI:7.1-15.9%) or SPP mid (12.2%, 95% CI:7.9-16.5%), but higher than SPP apical (10.6%, 95% CI:5.3-15.9%, p = 0.03). AHR (defined as a %ΔLV + dP/dt max ≥ 10%) varied between pacing configurations: 36% (9/25) for SPP apical, 44% (11/25) for SPP basal, 54% (13/24) for SPP mid, 56% (14/25) for 3P-MPP syn and 48% (11/23) for 3P-MPP seq.Fifteen patients (15/25, 60%) had an AHR in at least one pacing configuration. AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB (p = 0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population. Clinical Trial Registration:, identifier: NCT02914457.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Biosciences
College of Health & Life Sciences > Aston Medical School
College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG)
Additional Information: © 2022 Sterliński, Zakrzewska-Koperska, Maciąg, Sokal, Osca-Asensi, Wang, Spyropoulou, Maus, Lemme, Okafor, Stegemann, Cornelussen and Leyva. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Uncontrolled Keywords: Cardiovascular Medicine,heart failure,biventricular pacing,quadripolar lead for left ventricle pacing,multipoint pacing,acute hemodynamic effect,cardiac resynchronization therapy
Publication ISSN: 2297-055X
Full Text Link:
Related URLs: https://www.fro ... 022.901267/full (Publisher URL)
PURE Output Type: Article
Published Date: 2022-05-12
Accepted Date: 2022-04-19
Submitted Date: 2022-03-21
Authors: Sterliński, Maciej
Zakrzewska-Koperska, Joanna
Maciąg, Aleksander
Sokal, Adam
Osca-Asensi, Joaquin
Wang, Lingwei
Spyropoulou, Vasiliki
Maus, Baerbel
Lemme, Francesca
Okafor, Osita
Stegemann, Berthold (ORCID Profile 0000-0003-2841-8022)
Cornelussen, Richard
Leyva, Francisco



Version: Published Version

License: Creative Commons Attribution

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