Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy. Issue 9 (21st July 2021)

• Record Type: Journal Article
• Authors: Marques, Pedro; Nunes‐Ferreira, Afonso; Silvério António, Pedro; Aguiar‐Ricardo, Inês; Rodrigues, Tiago; Badie, Nima; Marcos, Ivo; Bernardes, Ana; Pinto, Fausto J; de Sousa, João
• Is Part Of: Pacing and clinical electrophysiology. Volume 44:Issue 9(2021)
• Page Start: 1577
• Page End: 1584
• Publication Date: 2021-07-21
• Subjects: cardiac resynchronization therapy -- heart failure -- MultiPoint pacing -- quality of life -- reverse remodeling; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.14319
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: 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.