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Electrical synchronization achieved by multipoint pacing combined with dynamic atrioventricular delay

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Abstract

Purpose

Multipoint pacing (MPP) improves left ventricular (LV) electrical synchrony in cardiac resynchronization therapy (CRT). SyncAV automatically adjusts atrioventricular delay (AVD) according to intrinsic AV intervals and may further improve synchrony. Their combination has not been assessed. The objective was to evaluate the improvement in electrical synchrony achieved by SyncAV combined with MPP in an international, multicenter study.

Methods

Patients with LBBB undergoing CRT implant with a quadripolar lead (Abbott Quartet™) were prospectively enrolled. QRS duration (QRSd) was measured by blinded observers from 12-lead ECG during: intrinsic conduction, BiV pacing (conventional biventricular pacing, nominal static AVD), MPP (2 LV cathodes maximally spaced, nominal static AVD), BiV + SyncAV, and MPP + SyncAV. All SyncAV offsets were individualized for each patient to yield the narrowest QRSd during BiV pacing. QRSd changes were compared by ANOVA and post hoc Tukey-Kramer tests.

Results

One hundred and three patients were enrolled (65.7 ± 12.1 years, 67% male, 37% ischemic, EF 26.4 ± 6.5%, PR 190.3 ± 39.1 ms). Relative to intrinsic conduction (QRSd of 165 ± 16 ms), BiV reduced QRSd by 11.9% to 145 ± 18 ms (P < 0.001 vs intrinsic), and MPP reduced QRSd by 13.3% to 142 ± 19 ms (P < 0.001 vs intrinsic). However, enabling SyncAV with a patient-optimized offset nearly doubled this QRSd reduction. BiV + SyncAV reduced QRSd by 22.0% to 128 ± 13 ms (P < 0.001 vs BiV), while MPP + SyncAV reduced QRSd further by 25.6% to 122 ± 14 ms (P < 0.05 vs BiV + SyncAV).

Conclusion

SyncAV can significantly improve acute electrical synchrony beyond conventional CRT, with further improvement achieved by superimposing MPP.

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Funding

This study was funded by the Abbott.

Author information

Authors and Affiliations

  1. GenesisCare Cardiology, Burgundy Street, Heidelberg, Victoria, 3084, Australia

    David O’Donnell, Taylah Smart, Michelle Ord & Tina Lin

  2. Austin Hospital, Heidelberg, Australia

    David O’Donnell & Michelle Ord

  3. Abbott, Cleveland, OH, USA

    Brian Wisnoskey & Gary Cranke

  4. Abbott, Sylmar, CA, USA

    Nima Badie, Lisa Odgers, Jan O. Mangual, Luke C. McSpadden & Kyungmoo Ryu

  5. Department of Cardiology, Monaldi Hospital, Naples, Italy

    Valter Bianchi & Antonio D’Onofrio

  6. Department of Arrhythmology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy

    Carlo Pappone

  7. Policlinico Casilino, Rome, Italy

    Leonardo Calò

  8. Barts Heart Centre, St. Bartholomew’s Hospital, London, UK

    Anthony Chow

  9. Cardiology Department, Oxford University Hospital, Oxford, UK

    Tim R. Betts

  10. Montreal Heart Institute, Montreal, Canada

    Bernard Thibault

  11. Cleveland Clinic, Cleveland, OH, USA

    Niraj Varma

Authors
  1. David O’Donnell
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  2. Brian Wisnoskey
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  3. Nima Badie
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  7. Tina Lin
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  8. Jan O. Mangual
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  15. Leonardo Calò
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  16. Anthony Chow
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  17. Tim R. Betts
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  18. Bernard Thibault
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  19. Niraj Varma
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Corresponding author

Correspondence to David O’Donnell.

Ethics declarations

All patients provided informed consent, and study protocols were approved by the ethics committee of each institution.

Conflict of interest

David O’Donnell received research grants and/or consultancy fees from Abbott, Boston Scientific, Biotronik, and Medtronic. Carlo Pappone and Bernard Thibault received research grants and/or consultancy fees from Abbott. Tim R. Betts has received research grants and/or consultancy fees from Abbott Medical, Boston Scientific, and Acutus Medical. Niraj Varma received research grants and/or consultancy fees from Abbott, Boston Scientific, Biotronik, and Medtronic. Brian Wisnoskey, Nima Badie, Lisa Odgers, Jan O. Mangual, Gary Cranke, Luke C. McSpadden, and Kyungmoo Ryu are Abbott employees. Taylah Smart, Michelle Ord, Tina Lin, Valter Bianchi, Antonio D’Onofrio, Leonardo Calò, and Anthony Chow have nothing to disclose.

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O’Donnell, D., Wisnoskey, B., Badie, N. et al. Electrical synchronization achieved by multipoint pacing combined with dynamic atrioventricular delay. J Interv Card Electrophysiol 61, 453–460 (2021). https://doi.org/10.1007/s10840-020-00842-7

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  • DOI: https://doi.org/10.1007/s10840-020-00842-7

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