AUTHOR=Sterliński Maciej , Zakrzewska-Koperska Joanna , Maciąg Aleksander , Sokal Adam , Osca-Asensi Joaquin , Wang Lingwei , Spyropoulou Vasiliki , Maus Baerbel , Lemme Francesca , Okafor Osita , Stegemann Berthold , Cornelussen Richard , Leyva Francisco 

TITLE=Acute Hemodynamic Effects of Simultaneous and Sequential Multi-Point Pacing in Heart Failure Patients With an Expected Higher Rate of Sub-response to Cardiac Resynchronization Therapy: Results of Multicenter SYNSEQ Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.901267

DOI=10.3389/fcvm.2022.901267

ISSN=2297-055X

ABSTRACT=The aim of the SYNSEQ  (Left Ventricular Synchronous versus Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP syn ) or sequential (3P-MPP seq) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS≤ 150 or the absence of LBBB (age: 66±12 years, QRS: 159±12 ms, NYHA class II/III, LVEF≤35%) underwent acute hemodynamic assessment by LV+dP/dtmax with a variety of LV pacing configurations at an optimized AV delay. The change in LV+dP/dt max (%∆LV+dP/dt max ) with 3P-MPP syn (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP seq (11.8%, 95% CI: 7.6% - 16.0%) nor to SPP basal (11.5%,95% CI:7.1%-15.9%) or SPP mid (12.2%,95% CI:7.9%–16.5%), but higher than SPP apical (10.6%, 95%CI:5.3%-15.9%,p=0.03). AHR (defined as a %∆LV+dP/dt max ≥10%) varied between pacing configurations: 36% (9/25) for SPP apical , 44% (11/25) for SPP basal , 54% (13/24) for SPP mid , 56% (14/25) for 3P-MPP syn and 48% (11/23) for 3P-MPP seq. Fifteen patients (15/25, 60%) had an AHR in at least one pacing configuration .  AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB (p=0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population.