Benefits of Multisite/Multipoint Pacing to Improve Cardiac Resynchronization Therapy Response

Thibault, Bernard; Mondésert, Blandine; Cadrin‐Tourigny, Julia; Dubuc, Marc; Macle, Laurent; Khairy, Paul

doi:10.1016/j.ccep.2018.11.016

Cited by 6 publications

(8 citation statements)

References 84 publications

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“…[3][4][5] Nonetheless, despite significant improvements over the last decade and the introduction of many optimization strategies, 25% to 30% of patient are consistently considered clinical non-responders across several studies. [4][5][6] Multipoint LV pacing (MPP) is a novel LV pacing modality that might increase the magnitude of clinical, hemodynamic, and echocardiographic response to CRT, [7][8][9][10][11][12] but uncertainty remains related to increased battery drain due to continuous pacing with an additional LV vector. The consequent need for device replacement due to battery exhaustion is of paramount importance in this patient population, as it is an invasive procedure that has been associated with nonsignificant rates of short-and long-term complications.…”

mentioning

confidence: 99%

Impact of multipoint pacing on projected battery longevity in cardiac resynchronization therapy. An IRON‐MPP study sub‐analysis

Forleo

Gasperetti

Ricciardi

et al. 2019

Cardiovasc electrophysiol

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Background Multipoint pacing (MPP) may improve clinical outcomes in patients with cardiac resynchronization therapy defibrillators (CRT‐D), but its impact on battery longevity in a real‐world population has not been investigated in large trials. Objective Compare projected battery longevity in CRT‐D patients with and without MPP during long‐term follow‐up. Methods The Italian registry on multipoint left ventricular pacing (IRON‐MPP) is a prospective, multicenter registry of patients implanted with MPP‐capable CRT‐D devices. Projected battery longevity during follow‐up was compared for patients with MPP (MPP ON) vs single‐site (MPP OFF) left ventricular pacing at CRT‐D implantation. A sub‐analysis excluded crossover patients with MPP activation or deactivation occurring after implantation. A second sub‐analysis excluded patients with a right or left ventricular pacing amplitude >2.5 V. Results Out of 237 CRT‐D patients (71 ± 9 years, 81% male) followed for 1.9 ± 0.8 years, 102 (43%) had MPP ON at implantation. Programmed atrial and ventricular outputs and percentage of pacing were similar between groups. MPP was associated with a 0.44 years reduction in projected battery longevity (P = .03) during long‐term follow‐up. Results were similar for the first and second sub‐analyses, with a 0.57 years (P < .001) and 0.71 years (P < .001) reduction in projected longevity, respectively. Conclusion In this long‐term real‐world registry, early MPP activation is associated with less than a 1‐year reduction in projected battery life compared to single‐site biventricular pacing.

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mentioning

confidence: 99%

Impact of multipoint pacing on projected battery longevity in cardiac resynchronization therapy. An IRON‐MPP study sub‐analysis

Forleo

Gasperetti

Ricciardi

et al. 2019

Cardiovasc electrophysiol

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“…MPP is preferred to MSP due to ease of implantation and programming as well as safety during implant (20% adverse events with MSP). [268][269][270] Since optimal lead placement can have anatomical or technical challenges, quadripolar leads (with a distal tip and 3-ring electrodes) can help with stability, optimal threshold obtainment, and avoidance of phrenic nerve stimulation, leading to decreases in LV lead-related intraoperative or postoperative events. Quadripolar LV pacing has less LV lead-related events intraoperatively and at 6 months compared to bipolar LV CS pacing.…”

Section: Multipoint Pacing Multisite Pacing and Quadripolar Leadsmentioning

confidence: 99%

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Chung

Patton

Lau³

et al. 2023

Journal of Arrhythmia

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Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing‐induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre‐procedure evaluation and preparation, implant procedure management, follow‐up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

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“…Different studies and meta-analyses have shown that MPP offers a more effective resynchronization therapy than conventional BVP. 16 Although the battery longevity is significantly shortened in patients undergoing MPP, this problem becomes more negligible compared to the benefit when the pacing capture threshold of the LV vector, which provides maximum possible anatomical separation, is ≤4.0 V. 17 …”

Section: Current Clinical Practice In Crt Implantationmentioning

confidence: 99%

Overview of Current Strategies Aiming at Improving Response to Cardiac Resynchronization Therapy

Yamantürk¹,

Candemir²,

Baskovski³

et al. 2022

Anatolian J Cardiol

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Cardiac resynchronization therapy is a treatment modality developed in the early 2000s that targets the mechanical and electrical dyssynchrony in heart failure with reduced ejection fraction patients. Appropriate patient selection conditions specified in the guidelines include measurement of left ventricular systolic dysfunction, QRS width, and assessment of functional classification. Despite consistent and increasing evidence supporting the use of cardiac resynchronization therapy in eligible patients, proportion of patients with the device is still not at the desired level. In addition, studies conducted in recent years have shown that the cardiac resynchronization therapy response of patients is quite heterogeneous and in echocardiographic follow-up, it was observed that reverse remodeling was not at the supposed level in approximately one-third of the patients. In order to change this result, which is due to many reasons, solutions such as using assistive imaging methods, providing optimal patient selection, trying different pacing techniques and post-procedural programming strategies (AV-delay and VV-delay optimization) have been the subject of debate. In this article, we aim to review the mechanisms that have been revealed regarding the differences in cardiac resynchronization therapy response and new pacing techniques—especially conduction system pacing—that may be preferred to resolve poor cardiac resynchronization therapy response.

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Benefits of Multisite/Multipoint Pacing to Improve Cardiac Resynchronization Therapy Response

Cited by 6 publications

References 84 publications

Impact of multipoint pacing on projected battery longevity in cardiac resynchronization therapy. An IRON‐MPP study sub‐analysis

Impact of multipoint pacing on projected battery longevity in cardiac resynchronization therapy. An IRON‐MPP study sub‐analysis

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Overview of Current Strategies Aiming at Improving Response to Cardiac Resynchronization Therapy

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