Estimation of the effects of multipoint pacing on battery longevity in routine clinical practice

Åkerström, Finn; Narváez, Irene; Puchol, Alberto; Pachón, Marta; Martín-Sierra, Cristina; Rodríguez‐Mañero, Moisés; Rodríguez‐Padial, Luis; Arias, Miguel Á.

doi:10.1093/europace/eux209

Cited by 25 publications

(27 citation statements)

References 13 publications

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“…In contrast, in the subgroup of patients for whom all ventricular outputs are ≤2.5 V, MPP would be anticipated to have a relatively greater impact on longevity. Backed by a larger sample and measured later in the follow‐up period, our data appear to be consistent with the previously reported experience . Whether or not the reported projected battery reduction represents a significant clinical dilemma and should support a more cautious approach towards more widespread use of the MPP strategy can not be determined with the currently available data.…”

Section: Discussionsupporting

confidence: 83%

“…We additionally performed an estimated MPP impact on battery drain stratifying by LV pacing amplitude, similar to the analysis performed in the Akerstrom et al study . Stratification cut‐off points were analogous to the one used in the Akerstrom et al study.…”

Section: Resultsmentioning

confidence: 99%

“…Before the current study, only a small study with 49 patients followed for a mean follow‐up of 11 months after device implantation had assessed this topic. The authors reported a statistically significant reduction of −5.6%, −16.9%, and −21.3% of battery life expectancy in MPP patients with <1.5 V, <4 V, and <6.5 V pacing capture thresholds, respectively …”

Section: Discussionmentioning

confidence: 95%

“…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 . To date, little is known about the real‐world impact of MPP on battery longevity, with only a small sample study dedicated to this topic . The goal of the present study is to partially fill that void by presenting the long‐term impact of MPP on projected battery life in the setting of a real‐world prospective multicenter registry.…”

Section: Introductionmentioning

confidence: 99%

“…13 To date, little is known about the real-world impact of MPP on battery longevity, with only a small sample study dedicated to this topic. 14 The goal of the present study is to partially fill that void by presenting the long-term impact of MPP on projected battery life in the setting of a real-world prospective multicenter registry.…”

mentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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Optimization of CRT programming using non‐invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing

Sieniewicz

Jackson

Claridge

et al. 2019

Journal of Arrhythmia

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Aim Quadripolar lead technology and multi‐point pacing ( MPP ) are important clinical adjuncts in cardiac resynchronization therapy ( CRT ) pacing aimed at reducing the rate of non‐response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization. Methods & Results We sought to investigate whether electrocardiographic imaging ( ECG i), using the CARDIOINSIGHT ™ inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECG i activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT ; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECG i voltage mapping. Conclusions Our work suggests a potential role for ECG i in the optimization of non‐responders to CRT , as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG .

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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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Estimation of the effects of multipoint pacing on battery longevity in routine clinical practice

Abstract: Multipoint pacing activation significantly reduces battery longevity compared with that for conventional CRT configuration. When reasonable MPP LV vector PCTs (≤4.0 V) are achieved, the decrease in battery longevity is relatively small which may prompt the clinician to activate MPP.

Cited by 25 publications

References 13 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

Optimization of CRT programming using non‐invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing

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

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