Acute Effects of Multisite Biventricular Pacing on Dyssynchrony and Hemodynamics in Canines With Heart Failure.

Abstract

BACKGROUND: Multisite biventricular pacing (MSP) has been proposed as an alternative strategy to improve the efficiency of conventional biventricular pacing (BVP), but its utility remains unclear. This study sought to investigate whether MSP induced better synchrony and hemodynamic effects in canines with heart failure. METHODS AND RESULTS: After 3 weeks' rapid right ventricular pacing, 7 canines were sutured with 4 left ventricular (LV) leads on the anterior, lateral, posterior, and apical walls and followed by MSP and BVP. Hemodynamic, electrocardiographic, and echocardiographic parameters were measured. Dyssynchrony was assessed by tissue Doppler imaging for Yu-index (longitudinal direction) and speckle tracking imaging for the standard deviation of time to peak radial strains (SD, radial direction). Compared with BVP, mean MSP reduced QRS width (P&#x2009;<&#x2009;.05), Yu-index (25.3&#x2009;&#xb1;&#x2009;1.9&#x2009;ms vs 31.6&#x2009;&#xb1;&#x2009;4.3&#x2009;ms, P&#x2009;=&#x2009;.008), SD(32.8&#x2009;&#xb1;&#x2009;5.9&#x2009;ms vs 37.3&#x2009;&#xb1;&#x2009;7.9&#x2009;ms, P&#x2009;=&#x2009;.032), and LV end-diastolic pressure (P&#x2009;<&#x2009;.05). The optimal pacing site combination improved QRS width, Yu-index, SD, LV end-diastolic pressure, and the maximum derivative of LV pressure (dP/dt) significantly (all P&#x2009;<&#x2009;.05), but the worst MSP (with the smallest dP/dt) did not show any improvement to BVP. CONCLUSIONS: MSP is superior to BVP in reducing dyssynchrony and improving hemodynamics. The pacing site combination has a potential effect on MSP response.