Optimized single‐point left ventricular pacing leads to improved resynchronization compared with multipoint pacing

Abstract

Background Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram‐based optimization using the fusion‐optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single‐point pacing (SPP) optimized by FOI. Methods This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP‐FOI, and MPP‐FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45‐day follow‐up. Results The SPP‐FOI method achieved greater QRS shortening than MPP (‐56 ± 16 vs. ‐42 ± 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP‐FOI: ‐58 ± 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 ± 2.3 vs. 6.3 ± 2.0 years, p = .03). Conclusions SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP.

Is Multipoint Pacing Superior to Optimized Single-Point Pacing?

“…In a recent study, we assessed the potential role of MPP in CRT by comparing MPP with SPP optimized by the fusion-optimized intervals (FOI) method. 2 This method consists of achieving fusion between the paced rhythm and intrinsic conduction by modifying the atrioventricular (AV) and interventricular delays. We compared a single-point left ventricular pacing strategy optimized by FOI (SPP-FOI) with MPP programmed with a fixed AV interval of 130 ms.…”

“Is multipoint pacing superior to optimized single‐point pacing?”—Authors' reply

“…We read with interest the letter from colleagues San Antonio et al 1 We acknowledge that the scope of the meta‐analysis was limited to multipoint pacing (MPP) without the potential benefit of fusion optimized intervals (FOI) methods being implemented. The a priori inclusion criteria and scope of our review did not encompass this.…”

“…This may in turn lead to improved coordinated contraction of the ventricles. The two studies highlighted utilize FOI with and without MPP and compare FOI directly to MPP only—demonstrating no clear benefit of using MPP in these circumstances 1,2 …”