Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy

• Published in: Pacing and clinical electrophysiology Vol. 44; no. 9; pp. 1577 - 1584
• Main Authors: Marques, Pedro, Nunes‐Ferreira, Afonso, Silvério António, Pedro, Aguiar‐Ricardo, Inês, Rodrigues, Tiago, Badie, Nima, Marcos, Ivo, Bernardes, Ana, Pinto, Fausto J, Sousa, João
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2021
• Subjects: Aged; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - methods; Cardiac Resynchronization Therapy Devices; Cardiomyopathy; Congestive heart failure; Dilated cardiomyopathy; Female; Heart failure; Heart Failure - therapy; Humans; Male; MultiPoint pacing; Patients; Prospective Studies; Prosthesis Implantation - methods; Quality of Life; reverse remodeling; Stroke Volume; Ventricle; Ventricular Remodeling; MultiPoint pacing; heart failure; reverse remodeling; quality of life; cardiac resynchronization therapy
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14319

Background Cardiac resynchronization therapy demonstrated benefits in heart failure. However, only 60–70% are responders and only 22% are super‐responders. MultiPoint pacing (MPP) improves structural remodeling, but data in responder patients is scarce. Methods A prospective, randomized study of the efficacy of MPP was conducted in patients who were CRT responders after 6 months of bi‐ventricular (BiV) therapy. At 6 months, responder patients (LV end‐systolic volume [LVESV] reduction ≥15%) were randomized to either continued BiV therapy or to MPP programmed with wide anatomical separation ≥30 mm, and followed until 12 months. Efficacy was determined by 6–12 month changes in LVESV and LV ejection fraction (LVEF). Evaluations of super‐responder rate (LVESV reduction ≥30%) and quality of life (NYHA, EQ‐5D, MLHFQ) were also performed. Results From February 2017 to February 2019, 73 CRTs with Quartet LV leads were implanted (42.9% female, 65.7 ± 10.8 years old, 79.5% dilated cardiomyopathy). At 6 months, 74.2% responded to BiV and were randomized to BiV (n = 25) or MPP (n = 24). MPP versus BiV delivered greater LVESV improvement (8.3% decrease in MPP vs. 10.3% increase in BiV patients, p = .047), greater increase in LVEF (7.7% vs. 1.8%, p = .008), and higher 0–12 month super‐responder rate (86.4% vs. 56.0%, p = .027). More MPP vs. BiV patients experienced an improvement in NYHA (84.6% vs. 50.0%, p = .047) and EQ‐5D (94.4% vs. 54.0%, p = .006). Conclusions MPP with wide anatomical spacing in CRT responder patients resulted in improved LV reverse remodeling with higher rates of super‐responders, and better quality of life metrics.