双室和左室多点起搏时动态房室延迟实现急性电同步

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-02-01 DOI:10.1016/j.cjco.2024.11.003

Bernard Thibault MD , Peter Waddingham MD , Nima Badie PhD , Jan O. Mangual PhD , Luke C. McSpadden PhD , Tim R. Betts MD , Leonardo Calò MD , Domenico Grieco MD , Francisco Leyva MD , Anthony Chow MD

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引用次数: 0

摘要

心脏再同步化治疗（CRT）的反应取决于两个因素：起搏的时间和地点。动态房室延迟（avd）（如SyncAV CRT， Abbott Cardiovascular, Abbott Park， IL）和多点左室起搏（如多点起搏[MPP]， Abbott）可能会增强这些因素。他们的个人和联合同步的贡献还没有在起搏配置的全面范围内进行评估。目的是区分静态vs动态avd、单位点vs多位点左室起搏、有右心室起搏vs无右心室起搏时的急性电同步性。方法ct提示左束支传导阻滞（LBBB）、房室传导（AV）完整(PR <；250 ms)，并在植入期间进行评估。在内源性传导、双心室起搏（BiV）、双心室MPP、单心室起搏（LVSS）和单心室MPP （LVMPP）时，评估12导联心电图（ECG） QRS持续时间（QRSd）的急性变化。采用静态avd和优化的SyncAV avd对CRT模式进行评价。结果85例患者完成了scrt植入和QRSd评估（男性71%，缺血性34%，PR 179 ms）。BiV、MPP、LVSS和不含SyncAV的LVMPP分别将165 ms的中位内在QRSd降低至144 ms（降低14%）、142 ms（16%）、155 ms（8%）和149 ms (12%) (P <；0.01 vs内在)。BiV + SyncAV、MPP + SyncAV、LVSS + SyncAV和LVMPP + SyncAV进一步显著降低了内在QRSd，分别为128 ms（23%）、124 ms（26%）、131 ms（21%）和129 ms (24%) (P <；0.0001，每对对应)。结论smpp联合SyncAV在所有可用部位（RV + LV1 + LV2）进行心室起搏，同时伴有动态avd，在总体人群和大多数患者中获得了最小的QRSd。临床注册号：03567096。

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Acute Electrical Synchronization Achieved With Dynamic Atrioventricular Delays During Biventricular and Left Ventricular MultiPoint Pacing

Background

Cardiac resynchronization therapy (CRT) response relies on 2 factors: when and where to pace. These factors may be enhanced by dynamic atrioventricular delays (AVDs) (eg, SyncAV CRT, Abbott Cardiovascular, Abbott Park, IL) and multisite left ventricular (LV) pacing (eg, 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 static vs dynamic AVDs, single-site vs multisite LV pacing, and with vs without right ventricular (RV) pacing.

Methods

CRT-indicated patients with left bundle branch block (LBBB) and intact atrioventricular (AV) conduction (PR < 250 ms) were enrolled and evaluated during implant. Acute changes in 12-lead electrocardiographic (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, 179 ms PR). The median intrinsic QRSd of 165 ms was reduced by BiV, MPP, LVSS, and LVMPP without SyncAV to 144 ms (by 14%), 142 ms (16%), 155 ms (8%), and 149 ms (12%), respectively (P < 0.01 vs intrinsic). BiV + SyncAV, MPP + SyncAV, LVSS + SyncAV, and LVMPP + SyncAV reduced the intrinsic QRSd significantly further to 128 ms (by 23%), 124 ms (26%), 131 ms (21%), and 129 ms (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.