Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing (MORE-CRT MPP) study: results from Phase I

Abstract

Aims To assess the impact of MultiPoint™ Pacing (MPP)—programmed according to the physician’s discretion—in non-responders to standard biventricular pacing after 6 months. Methods and results The study enrolled 1921 patients receiving a quadripolar cardiac resynchronization therapy (CRT) system capable of MPP™ therapy. A core laboratory assessed echocardiography at baseline and 6 months and defined volumetric non-response to biventricular pacing as <15% reduction in left ventricular end-systolic volume (LVESV). Clinical sites randomized patients classified as non-responders in a 1:1 ratio to receive MPP (236 patients) or continued biventricular pacing (231 patients) for an additional 6 months and evaluated rate of conversion to echocardiographic response. Baseline characteristics of both groups were comparable. No difference was observed in non-responder to responder conversion rate between MPP and biventricular pacing (31.8% and 33.8%, P = 0.72). In the MPP arm, 68 (29%) patients received MPP programmed with a wide LV electrode anatomical separation (≥30 mm) and shortest LV1–LV2 and LV2–RV timing delays (MPP-AS); 168 (71%) patients received MPP programmed with other settings (MPP-Other). MPP-AS elicited a significantly higher non-responder conversion rate compared to MPP-Other (45.6% vs. 26.2%, P = 0.006) and a trend in a higher conversion rate compared to biventricular pacing (45.6% vs. 33.8%, P = 0.10). Conclusions After 6 months, investigator-discretionary MPP programming did not significantly increase echocardiographic response compared to biventricular pacing in CRT non-responders.

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

“…Thus, some physicians may not resort to MPP strategy or may employ it through a “wait‐and‐see” approach, activating it only in those patients who do not respond to conventional CRT pacing. Importantly, this strategy has so far shown no benefit, as reported by the recent phase I results of the MORE‐CRT MPP study . Hence, there is a necessity of assessing MPP impact on battery life during long‐term follow‐up in a larger multi‐center registry.…”

“…Importantly, this strategy has so far shown no benefit, as reported by the recent phase I results of the MORE-CRT MPP study. 22 Hence, there is a necessity of assessing MPP finding should not be considered a substantial reason not to resort to MPP programming ab initio. On the other hand, given the patient characteristics (advanced age and several comorbidities) more commonly receiving CRT, and therefore possibly also MPP, therapy, this reduction may result impactful in terms of quality of life for these patients; therefore, the need for a worldwide, more standardized MPP implementation strategy remains and further data from multicentered randomized trials (alongside the phase II results of the MORE-CRT MPP trial) are needed to completely define MPP benefits and limitations.…”

Additional benefits of nonconventional modalities of cardiac resynchronization therapy using His bundle pacing

“…Conversely, the multicenter randomized V3 trial was a negative trial 39 . Similarly, the multipoint pacing trial 8 was a negative trial. None of the above studies considered triple pacing with HBP.…”

“…Persistence of wide QRS and an altered QRS axis on conventional CRT suggest incomplete electrical resynchronization. Although conventional biventricular pacing (CONV) is usually able to shorten QRS width, the magnitude of this shortening generally ranges from 20 to 30 ms and QRS almost invariably remains wide 3–8 . During conventional CRT, the QRS axis is greatly altered.…”

“…conventional biventricular pacing (CONV) is usually able to shorten QRS width, the magnitude of this shortening generally ranges from 20 to 30 ms and QRS almost invariably remains wide. [3][4][5][6][7][8] During conventional CRT, the QRS axis is greatly altered. The QRS complex is often positive in lead V1 and the axis on the frontal plane usually points to the right superior quadrant, suggesting a markedly altered sequence of electrical activation.…”