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Multisite pacing via a quadripolar lead for cardiac resynchronization therapy

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Abstract

Cardiac resynchronization therapy is challenging. Up to 40% of patients are non-responder. Multisite pacing via a quadripolar lead, also called multipoint/multipole pacing (MPP), is a debated alternative. In this review, we summarize evidence in the literature, tips and pitfalls related to MPP programming, and the different algorithms of MPP in different manufacturers.

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Abbreviations

biV:

biventricular

CRT:

cardiac resynchronization therapy

LV:

left ventricular

LV1:

first LV vector

LV2:

second LV vector

LVP:

left ventricle paced

LVS:

left ventricle sensed

LVEF:

left ventricle ejection fraction

LBBB:

left bundle branch block

MPP:

multipoint/multipole pacing

MPP-AS:

multipoint pacing–anatomic separation/minimal intraventricular timing delay

PNS:

phrenic nerve stimulation

PVC:

premature ventricular complexes.

RVP:

right ventricle paced

RVS:

right ventricle sensed

References

  1. Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003;289(20):2685–94. https://doi.org/10.1001/jama.289.20.2685.

    Article  PubMed  Google Scholar 

  2. Birnie DH, Tang AS. The problem of non-response to cardiac resynchronization therapy. Curr Opin Cardiol. 2006;21(1):20–6.

    Article  PubMed  Google Scholar 

  3. Chung ES, Leon AR, Tavazzi L, Sun J-P, Nihoyannopoulos P, Merlino J, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation. 2008;117(20):2608–16. https://doi.org/10.1161/CIRCULATIONAHA.107.743120.

    Article  PubMed  Google Scholar 

  4. Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues. Circ J. 2011;75(3):521–7.

    Article  PubMed  Google Scholar 

  5. Butter C, Auricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation. 2001;104(25):3026–9.

    Article  CAS  PubMed  Google Scholar 

  6. van Campen CMC, Visser FC, de Cock CC, Vos HS, Kamp O, Visser CA. Comparison of the haemodynamics of different pacing sites in patients undergoing resynchronisation treatment: need for individualisation of lead localisation. Heart. 2006;92(12):1795–800. https://doi.org/10.1136/hrt.2004.050435.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Becker M, Franke A, Breithardt OA, Ocklenburg C, Kaminski T, Kramann R, et al. Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography study. Heart. 2007;93(10):1197–203. https://doi.org/10.1136/hrt.2006.095612.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bleeker GB, Kaandorp TAM, Lamb HJ, Boersma E, Steendijk P, de Roos A, et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006;113(7):969–76. https://doi.org/10.1161/CIRCULATIONAHA.105.543678.

    Article  PubMed  Google Scholar 

  9. Spragg DD, Dong J, Fetics BJ, Helm R, Marine JE, Cheng A, et al. Optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2010;56(10):774–81. https://doi.org/10.1016/j.jacc.2010.06.014.

    Article  PubMed  Google Scholar 

  10. Derval N, Steendijk P, Gula LJ, Deplagne A, Laborderie J, Sacher F, et al. Optimizing hemodynamics in heart failure patients by systematic screening of left ventricular pacing sites: the lateral left ventricular wall and the coronary sinus are rarely the best sites. J Am Coll Cardiol. 2010;55(6):566–75. https://doi.org/10.1016/j.jacc.2009.08.045.

    Article  PubMed  Google Scholar 

  11. Singh JP, Klein HU, Huang DT, Reek S, Kuniss M, Quesada A, et al. Left ventricular lead position and clinical outcome in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) trial. Circulation. 2011;123(11):1159–66. https://doi.org/10.1161/CIRCULATIONAHA.110.000646.

    Article  PubMed  Google Scholar 

  12. Shetty AK, Sohal M, Chen Z, Ginks MR, Bostock J, Amraoui S, et al. A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study. Europace. 2014;16(6):873–9. https://doi.org/10.1093/europace/eut420.

    Article  PubMed  Google Scholar 

  13. Leclercq C, Gadler F, Kranig W, Ellery S, Gras D, Lazarus A, et al. A randomized comparison of triple-site versus dual-site ventricular stimulation in patients with congestive heart failure. J Am Coll Cardiol. 2008;51(15):1455–62. https://doi.org/10.1016/j.jacc.2007.11.074.

    Article  PubMed  Google Scholar 

  14. Ginks MR, Duckett SG, Kapetanakis S, Bostock J, Hamid S, Shetty A, et al. Multi-site left ventricular pacing as a potential treatment for patients with postero-lateral scar: insights from cardiac magnetic resonance imaging and invasive haemodynamic assessment. Europace. 2012;14(3):373–9. https://doi.org/10.1093/europace/eur336.

    Article  PubMed  Google Scholar 

  15. Rogers DPS, Lambiase PD, Lowe MD, Chow AWC. A randomized double-blind crossover trial of triventricular versus biventricular pacing in heart failure. Eur J Heart Fail. 2012;14(5):495–505. https://doi.org/10.1093/eurjhf/hfs004.

    Article  PubMed  Google Scholar 

  16. Lenarczyk R, Kowalski O, Sredniawa B, Pruszkowska-Skrzep P, Mazurek M, Jędrzejczyk-Patej E, et al. Implantation feasibility, procedure-related adverse events and lead performance during 1-year follow-up in patients undergoing triple-site cardiac resynchronization therapy: a substudy of TRUST CRT randomized trial. J Cardiovasc Electrophysiol. 2012;23(11):1228–36. https://doi.org/10.1111/j.1540-8167.2012.02375.x.

    Article  PubMed  Google Scholar 

  17. Bordachar P, Gras D, Clementy N, Defaye P, Mondoly P, Boveda S, et al. Clinical impact of an additional left ventricular lead in cardiac resynchronization nonresponders: the V3trial. Heart Rhythm. 2017;15:870–6. https://doi.org/10.1016/j.hrthm.2017.12.028.

    Article  PubMed  Google Scholar 

  18. Thibault B, Dubuc M, Khairy P, Guerra PG, Macle L, Rivard L, et al. Acute haemodynamic comparison of multisite and biventricular pacing with a quadripolar left ventricular lead. Europace. 2013;15(7):984–91. https://doi.org/10.1093/europace/eus435.

    Article  PubMed  Google Scholar 

  19. Rinaldi CA, Kranig W, Leclercq C, Kacet S, Betts T, Bordachar P, et al. Acute effects of multisite left ventricular pacing on mechanical dyssynchrony in patients receiving cardiac resynchronization therapy. J Card Fail. 2013;19(11):731–8. https://doi.org/10.1016/j.cardfail.2013.10.003.

    Article  PubMed  Google Scholar 

  20. Rinaldi CA, Leclercq C, Kranig W, Kacet S, Betts T, Bordachar P, et al. Improvement in acute contractility and hemodynamics with multipoint pacing via a left ventricular quadripolar pacing lead. J Interv Card Electrophysiol. 2014;40(1):75–80. https://doi.org/10.1007/s10840-014-9891-1.

    Article  PubMed  Google Scholar 

  21. Pappone C, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Ryu K, et al. Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients. Heart Rhythm. 2014;11(3):394–401. https://doi.org/10.1016/j.hrthm.2013.11.023.

    Article  PubMed  Google Scholar 

  22. Zanon F, Baracca E, Pastore G, Marcantoni L, Fraccaro C, Lanza D, et al. Multipoint pacing by a left ventricular quadripolar lead improves the acute hemodynamic response to CRT compared with conventional biventricular pacing at any site. Heart Rhythm. 2015;12(5):975–81. https://doi.org/10.1016/j.hrthm.2015.01.034.

    Article  PubMed  Google Scholar 

  23. Menardi E, Ballari GP, Goletto C, Rossetti G, Vado A. Characterization of ventricular activation pattern and acute hemodynamics during multipoint left ventricular pacing. Heart Rhythm. 2015;12(8):1762–9. https://doi.org/10.1016/j.hrthm.2015.04.029.

    Article  PubMed  Google Scholar 

  24. Pappone C, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Ryu K, et al. Improving cardiac resynchronization therapy response with multipoint left ventricular pacing: twelve-month follow-up study. Heart Rhythm. 2015;12(6):1250–8. https://doi.org/10.1016/j.hrthm.2015.02.008.

    Article  PubMed  Google Scholar 

  25. Osca J, Alonso P, Cano O, Andrés A, Miro V, Tello MJS, et al. The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results. Europace. 2016;18(4):560–7. https://doi.org/10.1093/europace/euv211.

    Article  PubMed  Google Scholar 

  26. Zanon F, Marcantoni L, Baracca E, Pastore G, Lanza D, Fraccaro C, et al. Optimization of left ventricular pacing site plus multipoint pacing improves remodeling and clinical response to cardiac resynchronization therapy at 1 year. Heart Rhythm. 2016;13(8):1644–51. https://doi.org/10.1016/j.hrthm.2016.05.015.

    Article  PubMed  Google Scholar 

  27. Siciliano M, Migliore F, Badano L, Bertaglia E, Pedrizzetti G, Cavedon S, et al. Cardiac resynchronization therapy by multipoint pacing improves response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo study. Europace. 2016. https://doi.org/10.1093/europace/euw331.

  28. Niazi I, Baker J, Corbisiero R, Love C, Martin D, Sheppard R, et al. Safety and efficacy of multipoint pacing in cardiac resynchronization therapy: the MultiPoint pacing trial. JACC Clinical electrophysiology. 2017;3(13):1510–8. https://doi.org/10.1016/j.jacep.2017.06.022.

    Article  PubMed  Google Scholar 

  29. Forleo GB, Santini L, Giammaria M, Potenza D, Curnis A, Calabrese V, et al. Multipoint pacing via a quadripolar left-ventricular lead: preliminary results from the Italian registry on multipoint left-ventricular pacing in cardiac resynchronization therapy (IRON-MPP). Europace. 2017;19(7):1170–7. https://doi.org/10.1093/europace/euw094.

    Article  PubMed  Google Scholar 

  30. Ciconte G, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Jiang C, et al. Multipoint pacing improves peripheral hemodynamic response: noninvasive assessment using radial artery tonometry. PACE. 2018;41(2):106–13. https://doi.org/10.1111/pace.13254.

    Article  PubMed  Google Scholar 

  31. Lercher P, Lunati M, Rordorf R, Landolina M, Badie N, Qu F, et al. Long-term reverse remodeling by cardiac resynchronization therapy with MultiPoint Pacing: a feasibility study of noninvasive hemodynamics-guided device programming. Heart Rhythm. 2018;15(12):1766–74. https://doi.org/10.1016/j.hrthm.2018.06.032.

    Article  PubMed  Google Scholar 

  32. Leclercq C, Burri H, Curnis A, Delnoy PP, Rinaldi CA, Sperzel J, et al. Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing (MORE-CRT MPP) study: results from phase I. Eur Heart J. 2019. https://doi.org/10.1093/eurheartj/ehz109.

  33. Sieniewicz BJ, Jackson T, Claridge S, Pereira H, Gould J, Sidhu B, et al. Optimization of CRT programming using non-invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing. J Arrhythm. 2019;35(2):267–75. https://doi.org/10.1002/joa3.12153.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sohal M, Shetty A, Niederer S, Lee A, Chen Z, Jackson T, et al. Mechanistic insights into the benefits of multisite pacing in cardiac resynchronization therapy: the importance of electrical substrate and rate of left ventricular activation. Heart Rhythm. 2015;12(12):2449–57. https://doi.org/10.1016/j.hrthm.2015.07.012.

    Article  PubMed  Google Scholar 

  35. Gasparini M, Galimberti P, Bragato R, Ghio S, Raineri C, Landolina M, et al. Multipoint pacing versus conventional ICD in patients with a narrow QRS complex (MPP narrow QRS trial): study protocol for a pilot randomized controlled trial. Trials. 2016;17(1):572. https://doi.org/10.1186/s13063-016-1698-1.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Akerström F, Narváez I, Puchol A, Pachón M, Martín-Sierra C, Rodríguez-Mañero M, et al. Estimation of the effects of multipoint pacing on battery longevity in routine clinical practice. Europace. 2017;20:1161–7. https://doi.org/10.1093/europace/eux209.

    Article  Google Scholar 

  37. Zanon F, Baracca E, Pastore G, Fraccaro C, Roncon L, Aggio S, et al. Determination of the longest intrapatient left ventricular electrical delay may predict acute hemodynamic improvement in patients after cardiac resynchronization therapy. Circ Arrhythm Electrophysiol. 2014;7(3):377–83. https://doi.org/10.1161/CIRCEP.113.000850.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France

    Alexandre Bodin, Arnaud Bisson, Clémentine Andre, Bertrand Pierre, Laurent Fauchier, Dominique Babuty & Nicolas Clementy

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  1. Alexandre Bodin
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Correspondence to Alexandre Bodin.

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LF: consultant or speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Livanova, Medtronic, and Novartis. DB: speaker for BMS/Pfizer and Medtronic. NC: consultant or speaker for Boston Scientific and Medtronic. Other authors—no conflicts of interest.

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Bodin, A., Bisson, A., Andre, C. et al. Multisite pacing via a quadripolar lead for cardiac resynchronization therapy. J Interv Card Electrophysiol 56, 117–125 (2019). https://doi.org/10.1007/s10840-019-00592-1

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