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Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy
Author(s) -
Marques Pedro,
NunesFerreira Afonso,
Silvério António Pedro,
AguiarRicardo Inês,
Rodrigues Tiago,
Badie Nima,
Marcos Ivo,
Bernardes Ana,
Pinto Fausto J,
Sousa João
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14319
Subject(s) - medicine , cardiac resynchronization therapy , ejection fraction , heart failure , cardiology , randomized controlled trial , ischemic cardiomyopathy , dilated cardiomyopathy , cardiomyopathy , quality of life (healthcare) , nursing
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.