Table_2_Acute Hemodynamic Effects of Simultaneous and Sequential Multi-Point Pacing in Heart Failure Patients With an Expected Higher Rate of Sub-response to Cardiac Resynchronization Therapy: Results of Multicenter SYNSEQ Study.docx

The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP syn) or sequential (3P-MPP seq) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS ≤ 150 or the absence of LBBB (age: 66 ± 12 years, QRS: 159 ± 12 ms, NYHA class II/III, LVEF ≤ 35%) underwent acute hemodynamic assessment by LV + dP/dtmax with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt max (%ΔLV + dP/dt max) with 3P-MPP syn (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP seq (11.8%, 95% CI: 7.6-16.0%) nor to SPP basal (11.5%, 95% CI:7.1-15.9%) or SPP mid (12.2%, 95% CI:7.9-16.5%), but higher than SPP apical (10.6%, 95% CI:5.3-15.9%, p = 0.03). AHR (defined as a %ΔLV + dP/dt max ≥ 10%) varied between pacing configurations: 36% (9/25) for SPP apical, 44% (11/25) for SPP basal, 54% (13/24) for SPP mid, 56% (14/25) for 3P-MPP syn and 48% (11/23) for 3P-MPP seq.Fifteen patients (15/25, 60%) had an AHR in at least one pacing configuration. AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB (p = 0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population.
Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT02914457.

SYNSEQ（心脏再同步治疗左心室同步vs序贯多部位起搏）研究旨在评估：对于存在心脏再同步治疗（Cardiac Resynchronization Therapy, CRT）应答不佳风险的患者群体，同步型（3P-MPP syn）或序贯型（3P-MPP seq）三点左心室多部位起搏（3-point-left-ventricular multi-spot pacing, 3P-MPP）相较于单点起搏（Single Point Pacing, SPP）的急性血流动力学应答（Acute Hemodynamic Response, AHR）情况。
本研究共纳入25例合并心肌瘢痕、QRS时限≤150ms或无左束支传导阻滞（Left Bundle Branch Block, LBBB）的患者，年龄为66±12岁，QRS时限为159±12ms，纽约心脏协会（New York Heart Association, NYHA）心功能分级Ⅱ/Ⅲ级，左心室射血分数（Left Ventricular Ejection Fraction, LVEF）≤35%。所有患者均在优化的房室延迟（AV delay）条件下，通过左心室压力最大上升速率（LV + dP/dtmax）对多种左心室起搏配置开展急性血流动力学评估。
同步型3P-MPP的左心室压力最大上升速率变化率（%ΔLV + dP/dtmax，即15.6%，95%置信区间：8.8%~22.5%），既未显著优于序贯型3P-MPP（11.8%，95%置信区间：7.6%~16.0%），也未显著优于基线单点起搏（SPP basal，11.5%，95%置信区间：7.1%~15.9%）或中位单点起搏（SPP mid，12.2%，95%置信区间：7.9%~16.5%），但显著高于心尖单点起搏（SPP apical，10.6%，95%置信区间：5.3%~15.9%，p=0.03）。
急性血流动力学应答（定义为左心室压力最大上升速率变化率≥10%）在不同起搏配置下的发生率存在差异：心尖单点起搏36%（9/25）、基线单点起搏44%（11/25）、中位单点起搏54%（13/24）、同步型3P-MPP 56%（14/25）、序贯型3P-MPP 48%（11/23）。共有15例患者（15/25，60%）在至少一种起搏配置下出现AHR。其中合并LBBB的患者中，77%（10/13）出现AHR，而非LBBB患者中仅为42%（5/12，p=0.11）。
综上，相较于单点起搏，同步或序贯型多点左心室起搏并未改善CRT应答不佳人群的急性血流动力学效应。
本研究已在ClinicalTrials.gov完成注册，注册号为NCT02914457。