Anodal Capture for Multisite Pacing with a Quadripolar Left Ventricular Lead: A Feasibility Study

Bodin, Alexandre, Bisson, Arnaud ORCID: 0000-0002-3449-1800, Andre, Clementine, Babuty, Dominique and Clementy, Nicolas (2021) Anodal Capture for Multisite Pacing with a Quadripolar Left Ventricular Lead: A Feasibility Study. JOURNAL OF CLINICAL MEDICINE, 10 (24). 5886-.

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Official URL: http://dx.doi.org/10.3390/jcm10245886

Abstract

<h4>Background</h4>Up to 40% of patients are CRT non-responders. Multisite pacing, using a unique quadripolar lead, also called multipoint/multipole pacing (MPP), is a potential alternative. We sought to determine the feasibility of intentional anodal capture using a single LV quadripolar lead, to reproduce MPP without the need of a specific algorithm (so-called "pseudo MPP").<h4>Methods</h4>Consecutive patients implanted with a commercially available CRT device and a quadripolar LV lead in our department were prospectively included. The electric charge (Q, in Coulomb) of RV and LV pacing spikes were calculated for all available LV pacing configurations at the threshold. The best MPP was defined as the configuration with the lowest consumption (Q<sub>RV</sub> + Q<sub>best LV1</sub> + Q<sub>best LV2</sub>). The best "pseudo MPP" (Q<sub>RV</sub> + Q<sub>LV1-LV2 with anodal capture</sub>) and best BVp (Q<sub>RV</sub> + Q<sub>best LV</sub>) were also calculated. A theoretical longevity was estimated for each configuration at the threshold without a safety margin.<h4>Results</h4>A total of 235 configurations were tested in 15 consecutive patients. "Pseudo-MPP" was feasible in 80% of patients with 3.1 ± 2.6 vectors available per-patient and LV<sub>proximal</sub>-LV<sub>distal</sub> (most distant electrodes) vectors were available in 47% of patients. Each MPP pacing spike electrical charge was comparable to "pseudo-MPP" (18,428 ± 6863 µC and 20,528 ± 5509 µC, respectively, <i>p</i> = 0.15). Theoretical longevity was 6.2 years for MPP, 5.6 years for "pseudo-MPP" and 13.7 years for BVp.<h4>Conclusions</h4>"Pseudo MPP" using intentional anodal capture with a quadripolar left ventricular lead, mimicking conventional multisite pacing, is feasible in most of CRT patients, with comparable energy consumption. Further studies on their potential clinical impact are needed.

Item Type:	Article
Uncontrolled Keywords:	anodal capture, cardiac resynchronization therapy, multipoint pacing, multisite pacing
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	18 Jan 2023 10:19
Last Modified:	30 Jan 2024 11:11
DOI:	10.3390/jcm10245886
Open Access URL:	https://doi.org/10.3390/jcm10245886
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3167115