Estimulación multipunto mediante captura anódica del ventrículo izquierdo a través de un electrodo cuadripolar: evaluación hemodinámica no invasiva

Abstract

IntroductionA high percentage of patients does not respond to resynchronization. Left anodal capture by means of high-voltage stimulation allows a multipoint stimulation that could increase the responders rate. ObjetiveTo assess viability and acute hemodynamic effectiveness of high voltage stimulation using the quadripolar lead Quartet 1458Q®. Methods18 consecutive patients with quadripolar lead were included. The capture was confirmed by means of electrocardiographic monitoring. Acute hemodynamic differences of anodal capture were compared (lead 1-cathode and 4-anode, maximum voltage and width), biventricular and right ventricular. Using the Task Force Monitor an acute hemodynamic analysis of systolic, diastolic and average blood pressure, stroke volume and index, cardiac output and index was conducted. For each variable the maximum, minimum and average values were reached during ten minute stable phases. Results18 patients (5 women - 27.8%) were analyzed, with an average age of 67.2 years (37-81); 33% with permanent atrial fibrillation and 39% with ischemic cardiopathology (only 5.6% with both). Anodal stimulation significantly raised the stroke volume and index, as well as the cardiac output and index compared to the biventricular mode [76.21 vs. 71.04ml (p=0.014); 40.67 vs. 37.88ml/m2 (p=0.018); 5.29 vs. 4.89 l/min (p=0.007); 2.86 vs. 2.65 l/min/m2 (p=0.007), respectively]. Subgroup analysis focused on the benefit for patients in sinus rhythm. ConclusionMultipoint stimulation by means of anodal capture using a quadripolar lead is possible. This further proves significant improvement in the stroke volume and cardiac output, though limited to the population in sinus rhythm.