Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

Ciconte, Giuseppe; Ćalović, Žarko; Vicedomini, Gabriele; Cuko, Amarild; McSpadden, Luke C.; Jiang, Chunlan; Ryu, Kyungmoo; Caporaso, Igor; Stutz, Robert M.; Winter, D. C.; Saviano, Massimo; Vitale, Raffaele; Conti, Manuel; Santinelli, Vincenzo; Pappone, Carlo

doi:10.1111/pace.13254

Cited by 5 publications

(2 citation statements)

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“…Thus, unless there is a large change in blood pressure, the pulse wave velocity will presumably remain constant during CRT testing, and any changes in PAT that occur when changing pacing can be attributed to changes in the PEP. 15 , 18 …”

Section: Discussionmentioning

confidence: 99%

Pulse arrival time variation as a non-invasive marker of acute response to cardiac resynchronization therapy

et al. 2023

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Aims Successful cardiac resynchronization therapy (CRT) shortens the pre-ejection period (PEP) which is prolonged in the left bundle branch block (LBBB). In a combined animal and patient study, we investigated if changes in the pulse arrival time (PAT) could be used to measure acute changes in PEP during CRT implantation and hence be used to evaluate acute CRT response non-invasively and in real time. Methods and results In six canines, a pulse transducer was attached to a lower limb and PAT was measured together with left ventricular (LV) pressure by micromanometer at baseline, after induction of LBBB and during biventricular pacing. Time-to-peak LV dP/dt (Td) was used as a surrogate for PEP. In twelve LBBB patients during implantation of CRT, LV and femoral pressures were measured at baseline and during five different pacing configurations. PAT increased from baseline (277 ± 9 ms) to LBBB (313 ± 16 ms, P < 0.05) and shortened with biventricular pacing (290 ± 16 ms, P < 0.05) in animals. There was a strong relationship between changes in PAT and Td in patients (r2 = 0.91). Two patients were classified as non-responders at 6 months follow-up. CRT decreased PAT from 320 ± 41 to 298 ± 39 ms (P < 0.05) in the responders, while PAT increased by 5 and 8 ms in the two non-responders. Conclusion This proof-of-concept study indicates that PAT can be used as a simple, non-invasive method to assess the acute effects of CRT in real time with the potential to identify long-term response in patients.

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Section: Discussionmentioning

confidence: 99%

Pulse arrival time variation as a non-invasive marker of acute response to cardiac resynchronization therapy

et al. 2023

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“…Для многополюсной стимуляции используют два катода, полученных с помощью четырех электродов [30][31][32]. При сравнении с бивентрикулярной стимуляцией установлено улучшение сократимости, гемодинамики и синхронизации между желудочками [33][34][35][36][37][38][39], особенно у пациентов, которые не склонны отвечать на терапию с помощью стандартной СРТ, то есть имеющих узкий комплекс QRS, атипичную морфологию блокады левой ножки пучка Гиса, I тип активации ЛЖ и рубцы миокарда [40][41][42]. Таким образом, в последнее время появляются сведения о многополюсной стимуляции ЛЖ при СРТ, которая вероятно увеличит количество пациентов, ответивших на лечение (респондеров).…”

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Multi-polar stimulation of the left ventricle during cardio-resynchronisation therapy in patients with congestive heart failure: Randomised pilot study outcomes from parallel groups

Ponomarenko¹,

Mikheenko²,

Morzhanayev³

et al. 2020

PKiK

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Background. Cardiac resynchronisation therapy (CRT) has been used for the treatment of patients with congestive heart failure (CHF) and wide QRS complexes for more than ten years. Nevertheless, the percentage of patients unresponsive to this therapy is 30%. There is recent evidence for increased responder proportions to treatments with multipolar pacing of the left ventricle (LV) in CRT. Accordingly, the aim of this study is to evaluate the effectiveness of multi-polar pacing of LV in patients with CHF and indications for CRT.Methods. Sixty-two patients [42 men, mean age 62.5 (58–68) years] with CHF and indications for CRT (for example patients with symptomatic heart failure and QRS duration ≥130 ms with left bundle branch block and left ventricular ejection fraction ≤ 35%) were included in this prospective, pilot, randomised study. Patients were implanted with cardiac resynchronisation devices with multi-polar electrodes. After implantation, patients were randomised into two groups according to the programming of the LV stimulation vector: true bipolar stimulation (group 1, stimulation vector LVring-LVtip, n = 31) and extended-bipolar LV stimulation (group 2, standard programming LV ring to RV, n = 31). The main objective of the study was to assess the effects of true bipolar stimulation on the increase of the number of CRT responders. Responders were defined as patients with a 15% decrease in the left ventricular end systolic volume compared with the initial characteristics as detected by echocardiography. Secondary points included changes in a) left ventricular ejection fraction (LVEF), b) 6-min walk test dynamics, and c) brain natriuretic peptide. The observation period was 12 months.Results. The LV electrode was implanted in the anterior (6%), antero-lateral (8%), lateral (18%), posterior (2%), or postero-lateral (66%) branches of the coronary sinus, and the average LV stimulation threshold was 1.7 ± 1.1 V. No intra-operative complications were detected. Four patients (6.5%) underwent LV electrode re-positioning on the second day after surgery owing to diaphragmatic nerve stimulation. At the end of the observation period, the average threshold used for LV stimulation of patients in the true bi-polar stimulation group with the LVring-LVtip vector was 1.9 ± 1.5 V compared with 1.6 ± 1.3 V in the case of the extended-bipolar LV stimulation group (p = 0.88). The number of responders in the true bipolar stimulation group was 25 (80.6%) compared with 21 (67.7%) patients in the extended-bipolar LV stimulation group (p = 0.38). LVEF significantly increased in both groups compared with pre-operative values without significant differences between the groups (29.4 vs. 36.5, p < 0.001 in the extended bipolar LV stimulation group; 28.0 vs. 34.9, p < 0.001 in the true bi-polar stimulation group, p = 0.86 between groups). The distance covered during the 6-min walk test significantly increased in both groups compared with pre-operative values in the absence of a significant difference between the groups (p = 0.92). The decreased levels of the cerebral natriuretic peptide were 60.3 ± 42.3 pg/ml and 56.6 ± 38.5 pg/ml in the extended and true bipolar stimulation groups, respectively (p = 0.95). Conclusion. Based on the results of this pilot study, the choice of a vector for true bipolar LV stimulation demonstrated its advantage and tendency to increase the number of responders in subjects with implanted CRT devices. Subsequent multi-centre randomised trials will help determine the role of true bipolar LV stimulation and extended-bipolar stimulation from different regions of the LV to increase the response to CRT. Received 24 December 2019. Revised 18 January 2020. Accepted 20 January 2020.Funding: The work is supported by a grant of the President of the Russian Federation No. МД-2893.2018.7.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: A.B. Romanov Data collection and analysis: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev, A.G. Filippenko, R.E. Zhizhov, I.S. Peregudov Statistical analysis: A.B. Romanov, I.L. Mikheenko Drafting the article: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev Critical revision of the article: A.B. Romanov, D.V. Losik, I.L. Mikheenko, A.V. Ponomarenko, V.V. Shabanov, S.N. Artemenko Final approval of the version to be published: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev, A.G. Filippenko, D.V. Losik, V.V. Shabanov, I.S. Peregudov, R.E. Zhizhov, A.B. Romanov, S.N. Artemenko

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Multisite pacing via a quadripolar lead for cardiac resynchronization therapy

Bodin

Bisson

André

et al. 2019

J Interv Card Electrophysiol

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Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

Cited by 5 publications

References 17 publications

Pulse arrival time variation as a non-invasive marker of acute response to cardiac resynchronization therapy

Pulse arrival time variation as a non-invasive marker of acute response to cardiac resynchronization therapy

Multi-polar stimulation of the left ventricle during cardio-resynchronisation therapy in patients with congestive heart failure: Randomised pilot study outcomes from parallel groups

Multisite pacing via a quadripolar lead for cardiac resynchronization therapy

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