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Title: Electrical synchronization achieved by multipoint pacing combined with dynamic atrioventricular delay.
Austin Authors: O'Donnell, David ;Wisnoskey, Brian;Badie, Nima;Odgers, Lisa;Smart, Taylah;Ord, Michelle;Lin, Tina;Mangual, Jan O;Cranke, Gary;McSpadden, Luke C;Ryu, Kyungmoo;Bianchi, Valter;D'Onofrio, Antonio;Pappone, Carlo;Calò, Leonardo;Chow, Anthony;Betts, Tim R;Thibault, Bernard;Varma, Niraj
Affiliation: Cardiology
GenesisCare Cardiology, Burgundy Street, Heidelberg, Victoria, 3084, Australia
Abbott, Cleveland, OH, USA..
Abbott, Sylmar, CA, USA..
Abbott, Cleveland, OH, USA..
Abbott, Sylmar, CA, USA..
Department of Cardiology, Monaldi Hospital, Naples, Italy..
Department of Arrhythmology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy..
Policlinico Casilino, Rome, Italy..
Barts Heart Centre, St. Bartholomew's Hospital, London, UK..
Cardiology Department, Oxford University Hospital, Oxford, UK..
Montreal Heart Institute, Montreal, Canada..
Cleveland Clinic, Cleveland, OH, USA..
Issue Date: Sep-2021
Date: 2020
Publication information: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing 2021; 61(3): 453-460
Abstract: Multipoint pacing (MPP) improves left ventricular (LV) electrical synchrony in cardiac resynchronization therapy (CRT). SyncAV automatically adjusts atrioventricular delay (AVD) according to intrinsic AV intervals and may further improve synchrony. Their combination has not been assessed. The objective was to evaluate the improvement in electrical synchrony achieved by SyncAV combined with MPP in an international, multicenter study. Patients with LBBB undergoing CRT implant with a quadripolar lead (Abbott Quartet™) were prospectively enrolled. QRS duration (QRSd) was measured by blinded observers from 12-lead ECG during: intrinsic conduction, BiV pacing (conventional biventricular pacing, nominal static AVD), MPP (2 LV cathodes maximally spaced, nominal static AVD), BiV + SyncAV, and MPP + SyncAV. All SyncAV offsets were individualized for each patient to yield the narrowest QRSd during BiV pacing. QRSd changes were compared by ANOVA and post hoc Tukey-Kramer tests. One hundred and three patients were enrolled (65.7 ± 12.1 years, 67% male, 37% ischemic, EF 26.4 ± 6.5%, PR 190.3 ± 39.1 ms). Relative to intrinsic conduction (QRSd of 165 ± 16 ms), BiV reduced QRSd by 11.9% to 145 ± 18 ms (P < 0.001 vs intrinsic), and MPP reduced QRSd by 13.3% to 142 ± 19 ms (P < 0.001 vs intrinsic). However, enabling SyncAV with a patient-optimized offset nearly doubled this QRSd reduction. BiV + SyncAV reduced QRSd by 22.0% to 128 ± 13 ms (P < 0.001 vs BiV), while MPP + SyncAV reduced QRSd further by 25.6% to 122 ± 14 ms (P < 0.05 vs BiV + SyncAV). SyncAV can significantly improve acute electrical synchrony beyond conventional CRT, with further improvement achieved by superimposing MPP.
DOI: 10.1007/s10840-020-00842-7
Journal: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
PubMed URL: 32740689
Type: Journal Article
Subjects: Atrioventricular delay
Cardiac resynchronization therapy
Heart failure
Multipoint pacing
QRS duration
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