Introduction: Up to 30% of CHF patients can be non responder to CRT. Multipoint Left Ventricular (LV) pacing (MPP) could help reducing the percentage of non responders relying upon usage of a quadripolar LV lead to deliver ventricular stimulation sequentially over three sites, LV distal (d), LV proximal (p), and right ventricle (RV). We present a case of quadrifocal pacing.
Methods: An 81 years old pt with ischemic cardiomyopathy (LVEDV 201 ml, LVESV 150 ml, LVEF 25%), permanent AF, previously implanted with a VVIR pacemaker with a lead in the RV apex (RVA), LBBB, NYHA class III, was upgraded to MPP CRT-Defibrillator (Quadra Assura MP™, St. Jude Medical, Sylmar, CA). A dual coil lead was screwed in the basal septum (IVS) and a quadripolar LV lead (Quartet™, St. Jude Medical, Sylmar, CA) was positioned in a postero-lateral coronary sinus branch. The old RV apical lead was connected to the atrial port of the CRT-D. Before discharge, QRS width and aortic VTI were evaluated pacing from one to four sites (table 1).
Results: At discharge, aortic VTI in quadrifocal pacing increased by 22% as compared to RVA pacing. At 1 year f-up NYHA class improved to II and LVEF to 42% (LVEDV 144 ml, LVESV 84 ml). QRS width decreased from 148 to 113 ms with quadrifocal pacing.
Conclusions: Quadrifocal pacing improves aortic VTI more than biventricular pacing in acute setting . At 1 year follow-up a 28% LVEDV and 44% LVESV decrease and a QRS width shortening were demonstrated.