Alejandro Liberos, Eduard Guasch, Felipe Atienza, Paz Garre, Andreu M. Climent, Francisco Alarcón, Rodolfo San Antonio, Marta Sitges, Lluís Mont, Omar Trotta, Maria S. Guillem, Margarida Pujol-López, Ivo Roca-Luque, Josep Brugada, Roger Borràs, Francisco Fernández-Avilés, José María Tolosana, Levio Quinto, Adelina Doltra, Elena Arbelo, Rafael Jiménez-Arjona, and Ana Gonzalez-Ascaso
[EN] 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 < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: -58 +/- 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 +/- 2.3 vs. 6.3 +/- 2.0 years, p = .03). Conclusions SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP., Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares, Grant/Award Number: CB16/11/00354; Instituto de Salud Carlos III, Grant/Award Numbers: DTS16/0160, PI16/00435, PI16/00703, PI17/01059, PI17/01106; Sociedad Espanola de Cardiologia, Grant/Award Numbers: 2018, SEC_ESTIM_01; Agencia deGestio d'Ajuts Universitaris i de Recerca, Grant/AwardNumber: 2017_SGR_1548; Fundacio laMarato de TV3, Grant/Award Number: 20152730; Horizon 2020 Framework Programme, Grant/Award Number: 633196 - CATCH MEproject; European Regional Development Fund, Grant/Award Number: EITHealth 19600 AFFINE