Multisite Left Ventricular Pacing for Cardiac Resynchronization
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1 Multisite Left Ventricular Pacing for Cardiac Resynchronization C. W. Israel, M.D. Ass. Prof. Dept. of Medicine Cardiology Evangelical Hospital Bielefeld Germany J. W. Goethe University Frankfurt
2 Potential conflicts of interest Consulting Biotronik, Boston-Scientific, LivaNova, Medtronic, St. Jude Medical/Abbott Employment in industry None Shareholder in a healthcare company None Owner of a healthcare company None Honoraria/speaker s bureau Biotronik, Boston-Scientific, LivaNova Medtronic, St. Jude Medical/Abbott Travel/congress reimbursement Biotronik, Boston-Scientific, LivaNova, Medtronic, St. Jude Medical/Abbott Participation in sponsored trials Biotronik, Boston-Scientific, LivaNova, Medtronic, St. Jude Medical/Abbott
3 Left Ventricular Activation Homogeneous septal-to-lateral activation Block with dispersed septal-tolateral activation Ginks, Circ Arrhythm Electrophysiol 2012; 5:
4 Multipoint Pacing and Scars
5 CRT with 2 LV Leads (Triple-Site Pacing) RVOT LV basal lateral LV posterior Leclercq, J Am Coll Cardiol 2008;51:
6 TRIP-HF Study Leclercq, J Am Coll Cardiol 2008;51:
7 RCTs with Triple-Site Pacing Martens, J Afib 2015;7:39-47
8 Ventricular Activation in Triple-Site Pacing Barberini, Eur Heart J 2015
9 Quadripolar Leads Biotronik Sentus QP Medtronic Attain Performa Boston Scientific Acuity X4 SJM Quartet
10 Multipoint Pacing (MPP) LV1 LV2 RV
11 Optimal LV Pacing Site 130 ms 120 ms 90 ms 105 ms
12 LV Pacing at the Site of Latest Activation Ypenburg, JACC 2008;52:1402-9
13 Acute Hemodynamics and Activation Time in Multipoint Pacing BiV MPP Multipoint pacing more uniform wavefront propagation throughout the LV compared to conventional biventricular pacing better electrical activation better acute hemodynamic response to CRT Menardi, Heart Rhythm 2015;12:1762-9
14 MPP Optimization: QRS Width Rinaldi, J Card Failure 2013;19:731-8
15 MPP: Acute Hemodynamics and Activation Time Menardi, Heart Rhythm 2015;12:1762-9
16 MPP: Better Synchronicity Rinaldi, J Interv Card Electrophysiol 2014;40:75 80
17 MPP: Better Synchronicity Osca, Europace 2015;18:560-7
18 MPP: Better Synchronicity n = 27 AS-P: Activation septal-posterior Osca, Europace 2015;18:560-7
19 MPP: Better Echo-Response n = 27 Osca, Europace 2015;18:560-7
20 MPP: Better Echo-Response Mean percent change in (A) cardiac index and (B) LVEF n = 27 Osca, Europace 2015;18:560-7
21 Quadripolar LV Leads: Mitral Regurgitation Valzania, J Interv Card Electrophysiol 2013;38:61-9
22 Hemodynamics and Electrical Delay Zanon, Heart Rhythm 2015;12:975 81
23 Multipoint Pacing in Non-Responders 7 of 9 patients with acute hemodynamic response (>10%) had a strict LBBB All 7 acute non-responders (AHR <10%) had a no strict LBBB Sohal, Heart Rhythm 2015;12:
24 RCTs with Multipoint Pacing Martens, J Afib 2015;7:39-47
25 Multipoint-Pacing: 12 Month Results Pappone, Heart Rhythm 2015;12:1250-8
26 Multipoint-Pacing: 12 Month Results Pappone, Heart Rhythm 2015;12:1250-8
![MPP: NYHA at 1 Year Conventional CRT(STD], n = 54 Hemodynamic/electrical optimization of the LV](/docs-images/83/88697257/images/27-1.jpg "pacingsite (OPT), n = 36 OPT combined with MPP (OPT+MPP), n = 20 Zanon, Heart Rhythm")
27 MPP: NYHA at 1 Year Conventional CRT(STD], n = 54 Hemodynamic/electrical optimization of the LV pacingsite (OPT), n = 36 OPT combined with MPP (OPT+MPP), n = 20 Zanon, Heart Rhythm 2016;13:
28 MPP: 1 Year Results Conventional CRT(STD], n = 54 Hemodyn./electrical optimization of LV pacing site (OPT), n = 36 OPT with MPP (OPT+MPP), n = 20 Zanon, Heart Rhythm 2016;13:
29 IRON-MPP Registry N = 507 Forleo, Europace 2016 (epub ahead of print)
30 IRON-MPP Registry Forleo, Europace 2016 (epub ahead of print)
31 IRON-MPP Registry: Months 150/232 (65%) absolute LVEF increase >5% Forleo, Europace 2016 (epub ahead of print)
32 Multisite LV Pacing for CRT Very solid data of better response to CRT Not for free (battery longevity ) Patient selection not yet clear Optimization (LV1, LV2, RV) not yet clear
33 East African Heart Rhythm Project Thank You for Your Attention!
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