Anodal Capture for Multisite Pacing with a Quadripolar Left Ventricular Lead: A Feasibility Study.

Alexandre Bodin,Dominique Babuty,Clémentine Andre,Nicolas Clementy,Arnaud Bisson

doi:10.3390/jcm10245886

Alexandre Bodin, Dominique Babuty + Show 3 more

Open Access

https://doi.org/10.3390/jcm10245886

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Abstract

Background: Up to 40% of patients are CRT non-responders. Multisite pacing, using a unique quadripolar lead, also called multipoint/multipole pacing (MPP), is a potential alternative. We sought to determine the feasibility of intentional anodal capture using a single LV quadripolar lead, to reproduce MPP without the need of a specific algorithm (so-called “pseudo MPP”). Methods: Consecutive patients implanted with a commercially available CRT device and a quadripolar LV lead in our department were prospectively included. The electric charge (Q, in Coulomb) of RV and LV pacing spikes were calculated for all available LV pacing configurations at the threshold. The best MPP was defined as the configuration with the lowest consumption (QRV + Qbest LV1 + Qbest LV2). The best “pseudo MPP” (QRV + QLV1–LV2 with anodal capture) and best BVp (QRV + Qbest LV) were also calculated. A theoretical longevity was estimated for each configuration at the threshold without a safety margin. Results: A total of 235 configurations were tested in 15 consecutive patients. “Pseudo-MPP” was feasible in 80% of patients with 3.1 ± 2.6 vectors available per-patient and LVproximal-LVdistal (most distant electrodes) vectors were available in 47% of patients. Each MPP pacing spike electrical charge was comparable to “pseudo-MPP” (18,428 ± 6863 µC and 20,528 ± 5509 µC, respectively, p = 0.15). Theoretical longevity was 6.2 years for MPP, 5.6 years for “pseudo-MPP” and 13.7 years for BVp. Conclusions: “Pseudo MPP” using intentional anodal capture with a quadripolar left ventricular lead, mimicking conventional multisite pacing, is feasible in most of CRT patients, with comparable energy consumption. Further studies on their potential clinical impact are needed.

Highlights

Cardiac resynchronization therapy (CRT) in heart failure showed a diminution of mortality and morbidity [1–6]
Consecutive patients implanted with a CRT device and a quadripolar LV lead in Consecutive patients implantedincluded
Dell’Era et al enrolled 30 CRT patients and tested, during the implantation procedure, the anodal capture on quadripolar leads from the three main manufacturers, using a Medtronic pacing-sensing analyzer [27]

Summary

Introduction

Cardiac resynchronization therapy (CRT) in heart failure showed a diminution of mortality and morbidity [1–6]. 4 electrodes), called multipoint/multipole pacing (MPP), is a safer and easier technique [12–14], which showed an improvement in hemodynamics and the functional status but remains debated and still needs more morbimortality evidence, especially through programming with large anatomical separation [15–23]. Multisite pacing, using a unique quadripolar lead, called multipoint/multipole pacing (MPP), is a potential alternative. We sought to determine the feasibility of intentional anodal capture using a single LV quadripolar lead, to reproduce MPP without the need of a specific algorithm (so-called “pseudo MPP”). Methods: Consecutive patients implanted with a commercially available CRT device and a quadripolar LV lead in our department were prospectively included. The electric charge (Q, in Coulomb) of RV and LV pacing spikes were calculated for all available LV pacing configurations at the threshold.

Methods

Results

Conclusion