Long-term Reverse Remodeling and Clinical Improvement by MultiPoint Pacing in a Randomized, International, Middle Eastern Heart Failure Study

Abstract

Introduction: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint Pacing, MPP) has been shown to improve CRT response, although MPP response using automated pacing vector programming has not been demonstrated in the Middle East. Objective: Compare the impact of MPP to conventional biventricular pacing (BiV) using echocardiographic and clinical changes at 6 months post-implant. Methods: This prospective, randomized study was conducted at 13 Middle Eastern centers. After de novo CRT-D implant (Abbott Unify Quadra MP or Quadra Assura MP) with quadripolar LV lead (Abbott Quartet), patients were randomized to either BiV or MPP therapy. In BiV patients, the LV pacing vector was selected per standard practice; in MPP patients, the two LV pacing vectors were selected automatically using VectSelect. CRT response was defined at 6 months post-implant by a reduction in LV end-systolic volume (ESV) [?]15%. Results: One-hundred and forty-two patients (61 years old, 68% male, NYHA class II/III/IV 19%/75%/6%, 33% ischemic, 57% hypertension, 52% diabetes, 158 ms QRS, 25.8% ejection fraction [EF]) were randomized to either BiV (N=69) or MPP (N=73). After 6 months,

Multipoint pacing for cardiac resynchronisation therapy in patients with heart failure: A systematic review and meta‐analysis

“…In the sensitivity analysis, excluding the abstracts by Al Mussad and Ferreira, resulted in no differences in the odds ratios and significance of results with regards to the prespecified endpoints 20,22 (Table 4).…”

“…A total of 2 were observational registry analyses, of which 1 was prospective, and 1 was retrospective. A total of 5 were fully published results, 7–10,19 1 was an abstract, 20 and 1 was a full‐text preprint of an earlier published abstract 21,22 (Table 1). In total 1390 patients were included in the final analysis (669 undergoing MPP, and 721 undergoing conventional CRT).…”

“…A sub‐analysis was performed of studies depending on type of MPP programming (as defined above), in the participants randomised to MPP vs conventional CRT. Two studies compared MPP‐AS only, 20,22 and two compared a combined cohort of MPP programming (MPP‐Mixed), 9,10 to conventional CRT. Three studies did not specify degree of final programming separation (MPP‐Other) 7,8,19 .…”

“…The current meta‐analysis adds important new data on the role of MPP from a quadripolar lead in the improvement of outcomes of CRT response and represents a critical addition to the literature evaluating the efficacy of MPP. Since the publication of a previous metanalysis by Hu et al there have been two major randomised trials 9,10 and two further preliminary randomised studies of MPP efficacy published 20–22 . The prior meta‐analysis of Hu et al incorporated smaller, non‐randomised studies with a high risk of bias.…”