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=9

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=<p>The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP <sub>syn</sub>) or sequential (3P-MPP <sub>seq</sub>) 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/dt<sub>max</sub> with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt <sub>max</sub> (%ΔLV + dP/dt <sub>max</sub>) with 3P-MPP <sub>syn</sub> (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP <sub>seq</sub> (11.8%, 95% CI: 7.6-16.0%) nor to SPP <sub>basal</sub> (11.5%, 95% CI:7.1-15.9%) or SPP <sub>mid</sub> (12.2%, 95% CI:7.9-16.5%), but higher than SPP <sub>apical</sub> (10.6%, 95% CI:5.3-15.9%, <italic>p</italic> = 0.03). AHR (defined as a %ΔLV + dP/dt <sub>max</sub> ≥ 10%) varied between pacing configurations: 36% (9/25) for SPP <sub>apical</sub>, 44% (11/25) for SPP <sub>basal</sub>, 54% (13/24) for SPP <sub>mid</sub>, 56% (14/25) for 3P-MPP <sub>syn</sub> and 48% (11/23) for 3P-MPP <sub>seq.Fifteen</sub> 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 (<italic>p</italic> = 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.</p><sec><title>Clinical Trial Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier: NCT02914457.</p></sec>