Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy

Abstract

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.