Thibault, Bernard, Waddingham, Peter, Badie, Nima, Mangual, Jan O., McSpadden, Luke C., Betts, Tim R., Calò, Leonardo, Grieco, Domenico, Leyva, Francisco and Chow, Anthony (2024). Acute Electrical Synchronization Achieved with Dynamic Atrioventricular Delays during Biventricular and Left Ventricular MultiPoint Pacing. CJC Open ,
Abstract
Background: Cardiac resynchronization therapy (CRT) response relies on two factors: when and where to pace. These factors may be enhanced by dynamic atrioventricular delays (AVDs) (e.g., SyncAV CRT, Abbott) and multi-site left ventricular (LV) pacing (e.g., 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 (i) static vs. dynamic AVDs, (ii) single- vs. multi-site LV pacing, and (iii) with vs. without RV pacing. Methods: CRT-indicated patients with LBBB and intact AV conduction (PR<250ms) were enrolled and evaluated during implant. Acute changes in 12-lead 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. Results: CRT implant and QRSd evaluation were completed in 85 patients (71% male, 34% ischemic, 179ms PR). The median intrinsic QRSd of 165ms was reduced by BiV, MPP, LVSS, and LVMPP without SyncAV to 144ms (by 14%), 142ms (16%), 155ms (8%), and 149ms (12%), respectively (P<0.01 vs. intrinsic). BiV+SyncAV, MPP+SyncAV, LVSS+SyncAV, and LVMPP+SyncAV reduced the intrinsic QRSd significantly further to 128ms (by 23%), 124ms (26%), 131ms (21%), and 129ms (24%) (P<0.0001, each corresponding pair). Conclusions: 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.
Publication DOI: | https://doi.org/10.1016/j.cjco.2024.11.003 |
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Divisions: | College of Health & Life Sciences College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG) College of Health & Life Sciences > Aston Medical School Aston University (General) |
Additional Information: | Copyright © 2024 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Publication ISSN: | 2589-790X |
Last Modified: | 31 Mar 2025 07:26 |
Date Deposited: | 03 Dec 2024 18:30 |
Full Text Link: | |
Related URLs: |
https://www.sci ... 589790X24005201
(Publisher URL) http://www.scop ... tnerID=8YFLogxK (Scopus URL) |
PURE Output Type: | Article |
Published Date: | 2024-11-08 |
Published Online Date: | 2024-11-08 |
Accepted Date: | 2024-11-05 |
Authors: |
Thibault, Bernard
Waddingham, Peter Badie, Nima Mangual, Jan O. McSpadden, Luke C. Betts, Tim R. Calò, Leonardo Grieco, Domenico Leyva, Francisco Chow, Anthony |
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