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.
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 ≥30mm, 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.
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 vs. BiV delivered greater LVESV improvement (8.3% decrease in MPP vs. 10.3% increase in BiV patients, p = 0.047), greater increase in LVEF (7.7% vs. 1.8%, p = 0.008), and higher 0-12 month super-responder rate (86.4% vs. 56.0%, p = 0.027). More MPP vs. BiV patients experienced an improvement in NYHA (84.6% vs. 50.0%, p = 0.047) and EQ-5D (94.4% vs. 54.0%, p = 0.006).
MultiPoint Pacing 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. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
About The Expert
Pedro Marques
Afonso Nunes-Ferreira
Pedro Silvério António
Inês Aguiar-Ricardo
Tiago Rodrigues
Nima Badie
Ivo Marcos
Ana Bernardes
Fausto J Pinto
João de Sousa
References
PubMed