Extending multipoint pacing CRT battery longevity by swapping left ventricular pulse configurations

Guerrero, Juan José García; Castañeda, Joaquín Fernández de la Concha; Piñero, Antonio; Martínez, Carlos Hidalgo; Badie, Nima; McSpadden, Luke C.; Ryu, Kyungmoo

doi:10.1007/s10840-020-00720-2

Cited by 4 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data suggest that even responder patients may further benefit from turning on MPP, which was functionally evident not only in echocardiographic changes (i.e., reverse remodeling) and a higher super‐responder rate at 12 months, but also in the improvement of several quality of life metrics. Although this study did not evaluate the impact of MPP on battery longevity, recent data show that the MPP‐related battery drain can be cut in half if programmed correctly 24 . A larger scale study focused specifically on responders could reveal that MPP may unlock the full potential of CRT for patients who already exhibit a satisfactory response to conventional BiV.…”

Section: Discussionmentioning

confidence: 97%

Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy

Marques

Nunes-Ferreira

Antonio

et al. 2021

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy

Marques

Nunes-Ferreira

Antonio

et al. 2021

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

show abstract

“…AVD values are often left at the nominal, off‐the‐shelf settings, rather than leveraging automated, programmer‐based AVD selection tools or performing manual optimization. Moreover, LV pacing is typically delivered from a single site even when a quadripolar lead is implanted, due to the added burden of MPP programming and potential battery longevity considerations, despite recent studies demonstrating battery savings using existing device features 18 . Achieving the maximal clinical potential of CRT for each patient, however, requires patient‐specific AVD optimization and LV pacing site selection.…”

Section: Discussionmentioning

confidence: 99%

Acute hemodynamic impact of atrioventricular delay and left ventricular pacing vector programming in MultiPoint Pacing

Wang

Cai

et al. 2022

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

Background The benefits of cardiac resynchronization therapy (CRT) in heart failure patients have been shown to depend on device programming, particularly atrioventricular delay (AVD) and left ventricular (LV) pacing site selection. This study compared the hemodynamic AVD optimization for commonly used biventricular (BiV) and MultiPoint Pacing(MPP, Abbott) LV vector selection strategies. Methods After de novo CRT‐D (Abbott Quadra Assura MP) and quadripolar LV lead (Abbott Quartet) implant, acute LV pressure was measured across a range of AVDs (60–225 ms) in four pacing modes: BiV with most proximal cathode, BiV with most distal cathode, MPP using two cathodes with earliest and latest right ventricle (RV)–LV activation times, and MPP using two cathodes with maximal anatomical separation. Hemodynamic improvement was evaluated by changes in maximum LV pressure first‐derivative versus RV pacing (ΔdP/dt). Results Twenty patients (64 years old, 68% male) completed the acute pacing protocol at six centers in China. Hemodynamic improvement versus RV pacing for BiV (proximal), BiV (Distal), MPP (electrical), and MPP (anatomical) was 22.1% ± 13.6%, 23.7% ± 13.4%, 24.5% ± 13.4%, and 25.1% ± 13.9%, respectively. The best MPP setting was marginally superior to the best BiV across all patients (25.8% ± 13.4% vs. 24.5% ± 13.1%, p = .040) and in the majority of patients (75.0% vs. 25.0%, p = .004). AVD programmed as little as 20 ms from optimum significantly reduced the ΔdP/dt benefit for all modes. Conclusions The maximal hemodynamic improvement across AV delays in this population was greater with MPP than BiV. Furthermore, patient‐specific AVD programming was critical in achieving the full hemodynamic response for all BiV and MPP modes.

show abstract

“…Few studies have specifically assessed the impact of MPP on battery longevity compared to conventional CRT. Of the included studies, Leclercq et al is the only to comment that MPP can reduce battery longevity by approximately 1 year (or approximately 15%), with a separate sub‐study of Spanish participants in the MORE‐CRT study demonstrated similar reductions in battery capacity of 15 ± 14% in those programmed to MPP‐AS 33 . A sub‐analysis of the IRON‐MPP study concluded that out of 237 patients followed up, MPP was associated with 0.44 years reduction in projected battery longevity 34 .…”

Section: Discussionmentioning

confidence: 99%

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

Mehta

Elliott

Sidhu

et al. 2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction Multipoint pacing (MPP) has been proposed as an effective way to improve cardiac resynchronisation therapy (CRT) response. We performed a systematic review and meta‐analysis evaluating the efficacy of CRT delivered via MPP compared to conventional CRT. Methods A literature search was performed from inception to January 2021 for studies in Medline, Embase and Cochrane databases, comparing MPP to conventional CRT with a minimum of 6 months follow‐up. Randomised and nonrandomised studies were assessed for relevant efficacy data including echocardiographic (left ventricular end systolic volume [LVESV] and ejection fraction) or functional changes (New York Heart Association [NYHA] class/Clinical Composite Score). Subgroup analyses were performed by study design and programming type. Results A total of 7 studies with a total of 1390 patients were included in the final analysis. Overall, MPP demonstrated greater echocardiographic improvement than conventional CRT in nonrandomised studies (odds ratio [OR]: 5.33, 95% confidence interval [CI]: [3.05–9.33], p < .001), however, was not significant in randomised studies (OR: 1.86, 95% CI: [0.91–3.79], p = .086). There was no significant difference in LVESV reduction >15% (OR: 1.96, 95% CI: [0.69–5.55], p = .20) or improvement by ≥1 NYHA class (OR: 2.49, 95% CI: [0.74–8.42], p = .141) when comparing MPP to conventional CRT. In a sub analysis, MPP programmed by widest anatomical separation (MPP‐AS) signalled greater efficacy, however, only 120 patients were included in this analysis. Conclusion Overall MPP was more efficacious in nonrandomised studies, and not superior when assessed in randomised studies. There was considerable heterogeneity in study design making overall interpretation of results challenging. Widespread MPP programming in all CRT patients is currently not justified. Further large, randomised studies with patient‐specific programming may clarify its effectiveness.

show abstract

Extending multipoint pacing CRT battery longevity by swapping left ventricular pulse configurations

Cited by 4 publications

References 11 publications

Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy

Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy

Acute hemodynamic impact of atrioventricular delay and left ventricular pacing vector programming in MultiPoint Pacing

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

Contact Info

Product

Resources

About