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Single-Point Left Ventricular Pacing Optimized by ECG Results in Better Resynchronization than Multipoint Pacing
  • +19
  • Rodolfo San Antonio,
  • Eduard Guasch,
  • Ana González-Ascaso,
  • Rafael Jiménez-Arjona,
  • Andreu Climent,
  • Margarida Pujol-Lopez,
  • Adelina Doltra,
  • Francisco Alarcón,
  • Paz Garre,
  • Alejandro Liberos,
  • Omar Trotta,
  • Levio Quinto,
  • Roger Borràs,
  • Elena Arbelo,
  • Ivo Roca-Luque,
  • Felipe Atienza,
  • Josep Brugada,
  • Francisco Fernández-Avilés,
  • María Guillem,
  • Marta Sitges,
  • Jose Maria Tolosana,
  • Luis Mont Girbau
Rodolfo San Antonio
Hospital Clinic de Barcelona
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Eduard Guasch
Hospital Clinic de Barcelona
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Ana González-Ascaso
Universitat Politecnica de Valencia
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Rafael Jiménez-Arjona
Hospital Clinic de Barcelona
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Andreu Climent
Universitat Politecnica de Valencia
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Margarida Pujol-Lopez
Hospital Clinic de Barcelona
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Adelina Doltra
Hospital Clinic de Barcelona
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Francisco Alarcón
Hospital Clinic de Barcelona
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Paz Garre
Hospital Clinic de Barcelona
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Alejandro Liberos
Universitat Politecnica de Valencia
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Omar Trotta
Hospital Clinic de Barcelona
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Levio Quinto
Hospital Clinic de Barcelona
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Roger Borràs
Hospital Clínic
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Elena Arbelo
Hospital Clinic, Universitat de Barcelona;
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Ivo Roca-Luque
Hospital Clinic de Barcelona
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Felipe Atienza
Gregorio Maranon General University Hospital Cardiology Service
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Josep Brugada
Hospital Clinic
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Francisco Fernández-Avilés
Gregorio Maranon General University Hospital Cardiology Service
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María Guillem
Universitat Politecnica de Valencia
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Marta Sitges
Hospital Clinic de Barcelona
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Jose Maria Tolosana
Hospital Clinic, Universitat de Barcelona;
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Luis Mont Girbau
Hospital Clinic de Barcelona
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Abstract

Background: Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods: This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results: The SPP-FOI method achieved greater QRS shortening than MPP (-56±16 vs. -42±17 ms, P<0.001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: - 58±14 ms, P=0.69). Furthermore, the biventricular activation time according to ECGI was also shorter with SPP-FOI than with MPP. The estimated battery longevity was longer with SPP than with MPP (8.1±2.3 vs. 6.3±2.0 years, P=0.03). Conclusions: SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP.