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2 results on '"Left ventricular pacing configurations"'

1. 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).

Author

Forleo*, Giovanni B., Santini, Luca, Giammaria, Massimo, Potenza, Domenico, Curnis, Antonio, Calabrese, Vito, Ricciardi, Danilo, D'agostino, Carlo, Notarstefano, Pasquale, Ribatti, Valentina, Morani, Giovanni, Mantica, Massimo, Di Biase, Luigi, Bertaglia, Emanuele, Calò, Leonardo, and Zanon, Francesco

Abstract

Aims: This registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices.Methods and Results: A total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to 'ON' in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to 'ON' (n = 94) or 'OFF' (n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly (P < 0.001).Conclusion: This study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF.Clinical Trial Registration: http://www.clinicaltrial.gov/. Unique identifier: NCT02606071. [ABSTRACT FROM AUTHOR]

Published
2017
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2. 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)

Author

Giovanni B. Forleo, Giovanni Morani, Valentina Ribatti, Antonio Curnis, Emanuele Bertaglia, Domenico Potenza, Massimo Mantica, Danilo Ricciardi, Pasquale Notarstefano, Francesco Zanon, Massimo Giammaria, Carlo D'agostino, Luigi Di Biase, Luca Santini, Leonardo Calò, and Vito Calabrese

Subjects
MPP, Male, Time Factors, Ventricular lead, medicine.medical_treatment, Action Potentials, 030204 cardiovascular system & hematology, Multipoint pacing, Ventricular Function, Left, Cardiac Resynchronization Therapy, 0302 clinical medicine, Heart Rate, Risk Factors, Odds Ratio, 030212 general & internal medicine, Prospective Studies, Registries, Left ventricular pacing configurations, Ejection fraction, Equipment Design, Middle Aged, Pacing and Resynchronization Therapy, Treatment Outcome, Italy, Cardiology, Female, Cardiology and Cardiovascular Medicine, Optimization, medicine.medical_specialty, Cardiac resynchronization therapy, Heart failure, 03 medical and health sciences, QRS complex, Clinical Research, Physiology (medical), Internal medicine, medicine, Humans, Cardiac Resynchronization Therapy Devices, Healthcare Disparities, Aged, Chi-Square Distribution, business.industry, Stroke Volume, Odds ratio, Recovery of Function, Ventricular pacing, medicine.disease, Clinical trial, Logistic Models, Multivariate Analysis, business
Abstract

Aims This registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices. Methods and results A total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to ‘ON’ in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to ‘ON’ ( n = 94) or ‘OFF’ ( n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly ( P < 0.001). Conclusion This study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF. Clinical Trial Registration . Unique identifier: [NCT02606071][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02606071&atom=%2Feuropace%2Fearly%2F2016%2F05%2F16%2Feuropace.euw094.atom

Published
2016

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