Clinical Effect Of Left Ventricular Multipoint Pacing In Patients With Chronic Moderate And Severe Heart Failure

Objective To evaluate the efficacy and safety of left ventricular multipoint pacing in patients with chronic moderate to severe heart failure.Method 25 patients with chronic heart failure admitted to our department from September 2017 to may 2019 were analyzed retrospectively,all of which met the class I or class II indications of CRT implantation recommended in the 2016 ESC diagnosis and treatment of acute and chronic heart failure guidelines.Inclusion criteria:(1)sinus rhythm;(2)QRS wave duration greater than 130 ms;(3)LVEF ≤ 35%;(4)NYHA heart function class III-IV;(5)standard drug treatment(including β-receptor blocker,ACEI or ARB / ARNI,aldosterone receptor blocker),diuretics,etc.,except for contraindications or intolerable)after 3 months,there are still recurrent heart failure.All the selected patients successfully implanted the left ventricular quadrupole electrode(quartz TM)with multi-point pacing function in CRT.Among them,there were 13 males and 12 females,with an average age of(62.7 ± 10.4)years;14 patients with dilated cardiomyopathy and 11 patients with coronary atherosclerotic heart disease;23 patients with complete left bundle branch and 2 patients with non left bundle branch block;15 patients with NYHA class III and 10 patients with NYHA class IV.The left ventricular electrodes were implanted into the target vessels: 8 lateral veins,15 posterior veins and 2 anterior veins.All patients were treated with standard oral medicine.Observation indexes:(1)NYHA cardiac function grade,ntprobnp,6MWD,QRS time limit,LVEF,LVEDd,LVESD and other indexes before and 6 months.The clinical response rate and ultrasound response rate were calculated.(2)Complications and device related adverse events(pericardial tamponade,phrenic nerve stimulation,capsular infection,left ventricular threshold rise,electrode dislocation,death,etc.)were analyzed during the follow-up period of 6 months.Result(1)In terms of effectiveness: compared with the parameters of patients with MPP mode heart failure before and 6 months after operation,patients with 6 months after operation had shorter QRS time limit,smaller levels of LVEDd,LVESD and ntprobnp,higher LVEF and further 6MWD(P < 0.01).Among them,the NYHA cardiac function grade of 22 patients was improved ≥ 1 or the 6-minute walking distance was increased by 20%,the clinical response rate of CRT was 88%(22 / 25),the LVEF of 20 patients was increased ≥ 10% compared with the baseline level,and the ultrasonic response rate was 80%(20 / 25).(2)Safety aspect: 1 case(4%)had phrenic nerve stimulation after operation.After adjusting pacing vector,PNS was improved.One case(4%)had cystic infection after operation.The wire was removed and the implanted site was replaced.One patient(4%)died of malignant arrhythmia due to the development of heart failure.During the follow-up of the other 22 patients,there were no cases of pericardial tamponade,bag infection,left ventricular lead threshold increase,left ventricular lead dislocation,PNS and so on.Conclusion On the basis of standard drug treatment,CRT-MPP has good efficacy and safety in patients with chronic moderate and severe heart failure with QRS wave time limit >130 ms.