Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial

Gasparini, Maurizio; Galimberti, Paola; Bragato, Renato; Ghio, Stefano; Raineri, Claudia; Landolina, Maurizio; Chieffo, Enrico; Lunati, Maurizio; Mulargia, Ederina; Proclemer, Alessandro; Facchin, Domenico; Rordorf, Roberto; Vicentini, Alessandro; Marcantoni, Lina; Zanon, Francesco; Klersy, Catherine

doi:10.1186/s13063-016-1698-1

Cited by 5 publications

(3 citation statements)

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“…The most important of them, already registered on clinicaltrials. gov, are the MORE-CRT-MPP PHASE II trial 43 (a large clinical study whose primary outcome is the response to CRT after 6 months of MPP), IMAGE-CRT 44 (a cohort study whose primary outcome is the CRT response of a type of MPP configuration), MPP Narrow QRS 45 (a randomized clinical trial involving patients with narrow QRS-100 to 130 ms-whose primary outcome is "reverse remodeling" with MPP vs implantable cardiac defibrillator), and the HUMVEE trial 44,46 (a case-crossover prospective study whose primary outcomes are the improvement of ventriculoarterial coupling and the improvement of energy efficiency). The results of these studies and of other clinical trials will certainly help clarify the questions that remain open after our review work.…”

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

et al. 2021

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BACKGROUND Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) therapy, as it has reduced mortality and morbidity and has shown improvement in functional capacity. Multipoint pacing (MPP) is a way of configuring CRT with the aim to improve the percentage of patients who respond to CRT.OBJECTIVE To demonstrate the effectiveness of the MPP compared to traditional biventricular pacing (BiV).METHODS We performed a systematic review and meta-analysis according to PRISMA guidelines of studies in which MPP vs BiV strategy were compared.RESULTS MPP use is associated with a higher rate of patients experiencing functional improvement (odds ratio: 2.51, 95% confidence interval [CI], 1.56-4.06; P 5 .0002) and with higher delta LV dP/ dt max (mean difference, 1.82; 95% CI, 0.24-3.39; P 5 .0240) with respect to BiV. MPP and BiV have no significantly different effect on left ventricular end-systolic volume (LVESV) (mean difference, 0.39; 95% CI, -11.12 to 11.89; P 5 .9475); moreover, there is no significant difference between the 2 treatments regarding hospitalization for HF (odds ratio, 0.70; 95% CI, 0.32 to 1.54; P 5 .3816) and all-cause death (odds ratio, 0.81; 95% CI, 0.40 to 1.62; P 5 .5460). MPP is associated with a significantly lower projected battery longevity (mean difference -8.66 months; 95% CI, -13.67 to -3.66; P 5 .00007) with respect to BiV.CONCLUSION MPP significantly improves functional class and acute hemodynamic parameters with respect to BiV. Prognostic indices and LVESV are not significantly influenced by MPP. MPP is associated with a significant reduction in projected battery longevity.

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Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

et al. 2021

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“…Для многополюсной стимуляции используют два катода, полученных с помощью четырех электродов [30][31][32]. При сравнении с бивентрикулярной стимуляцией установлено улучшение сократимости, гемодинамики и синхронизации между желудочками [33][34][35][36][37][38][39], особенно у пациентов, которые не склонны отвечать на терапию с помощью стандартной СРТ, то есть имеющих узкий комплекс QRS, атипичную морфологию блокады левой ножки пучка Гиса, I тип активации ЛЖ и рубцы миокарда [40][41][42]. Таким образом, в последнее время появляются сведения о многополюсной стимуляции ЛЖ при СРТ, которая вероятно увеличит количество пациентов, ответивших на лечение (респондеров).…”

Section: Discussionunclassified

Multi-polar stimulation of the left ventricle during cardio-resynchronisation therapy in patients with congestive heart failure: Randomised pilot study outcomes from parallel groups

Ponomarenko¹,

Mikheenko²,

Morzhanayev³

et al. 2020

PKiK

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Background. Cardiac resynchronisation therapy (CRT) has been used for the treatment of patients with congestive heart failure (CHF) and wide QRS complexes for more than ten years. Nevertheless, the percentage of patients unresponsive to this therapy is 30%. There is recent evidence for increased responder proportions to treatments with multipolar pacing of the left ventricle (LV) in CRT. Accordingly, the aim of this study is to evaluate the effectiveness of multi-polar pacing of LV in patients with CHF and indications for CRT.Methods. Sixty-two patients [42 men, mean age 62.5 (58–68) years] with CHF and indications for CRT (for example patients with symptomatic heart failure and QRS duration ≥130 ms with left bundle branch block and left ventricular ejection fraction ≤ 35%) were included in this prospective, pilot, randomised study. Patients were implanted with cardiac resynchronisation devices with multi-polar electrodes. After implantation, patients were randomised into two groups according to the programming of the LV stimulation vector: true bipolar stimulation (group 1, stimulation vector LVring-LVtip, n = 31) and extended-bipolar LV stimulation (group 2, standard programming LV ring to RV, n = 31). The main objective of the study was to assess the effects of true bipolar stimulation on the increase of the number of CRT responders. Responders were defined as patients with a 15% decrease in the left ventricular end systolic volume compared with the initial characteristics as detected by echocardiography. Secondary points included changes in a) left ventricular ejection fraction (LVEF), b) 6-min walk test dynamics, and c) brain natriuretic peptide. The observation period was 12 months.Results. The LV electrode was implanted in the anterior (6%), antero-lateral (8%), lateral (18%), posterior (2%), or postero-lateral (66%) branches of the coronary sinus, and the average LV stimulation threshold was 1.7 ± 1.1 V. No intra-operative complications were detected. Four patients (6.5%) underwent LV electrode re-positioning on the second day after surgery owing to diaphragmatic nerve stimulation. At the end of the observation period, the average threshold used for LV stimulation of patients in the true bi-polar stimulation group with the LVring-LVtip vector was 1.9 ± 1.5 V compared with 1.6 ± 1.3 V in the case of the extended-bipolar LV stimulation group (p = 0.88). The number of responders in the true bipolar stimulation group was 25 (80.6%) compared with 21 (67.7%) patients in the extended-bipolar LV stimulation group (p = 0.38). LVEF significantly increased in both groups compared with pre-operative values without significant differences between the groups (29.4 vs. 36.5, p < 0.001 in the extended bipolar LV stimulation group; 28.0 vs. 34.9, p < 0.001 in the true bi-polar stimulation group, p = 0.86 between groups). The distance covered during the 6-min walk test significantly increased in both groups compared with pre-operative values in the absence of a significant difference between the groups (p = 0.92). The decreased levels of the cerebral natriuretic peptide were 60.3 ± 42.3 pg/ml and 56.6 ± 38.5 pg/ml in the extended and true bipolar stimulation groups, respectively (p = 0.95). Conclusion. Based on the results of this pilot study, the choice of a vector for true bipolar LV stimulation demonstrated its advantage and tendency to increase the number of responders in subjects with implanted CRT devices. Subsequent multi-centre randomised trials will help determine the role of true bipolar LV stimulation and extended-bipolar stimulation from different regions of the LV to increase the response to CRT. Received 24 December 2019. Revised 18 January 2020. Accepted 20 January 2020.Funding: The work is supported by a grant of the President of the Russian Federation No. МД-2893.2018.7.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: A.B. Romanov Data collection and analysis: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev, A.G. Filippenko, R.E. Zhizhov, I.S. Peregudov Statistical analysis: A.B. Romanov, I.L. Mikheenko Drafting the article: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev Critical revision of the article: A.B. Romanov, D.V. Losik, I.L. Mikheenko, A.V. Ponomarenko, V.V. Shabanov, S.N. Artemenko Final approval of the version to be published: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev, A.G. Filippenko, D.V. Losik, V.V. Shabanov, I.S. Peregudov, R.E. Zhizhov, A.B. Romanov, S.N. Artemenko

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“…50,51 Multiple larger trials are currently ongoing to better evaluate the safety and efficacy of MPP systems to enhance CRT response in all-comers, 52 CRT nonresponders, 53 and patients with narrow QRS complexes. 54…”

Section: Multipoint (Or Multisite) Pacingmentioning

confidence: 99%

Advances in Cardiac Resynchronization Therapy

Jafferani

Leal

2019

J Innov Cardiac Rhythm Manage.

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The development of cardiac resynchronization therapy (CRT) has been crucial in reducing morbidity and mortality in patients with advanced heart failure. However, a significant proportion of patients who receive CRT fail to derive significant clinical benefits from this therapy. Successful CRT depends on a multitude of factors, including appropriate patient selection, left ventricular lead positioning, and postimplant management. Newer device-based algorithms, multipoint ventricular pacing, and the development of leadless CRT devices constitute important facets of both the present and near-future evolution of this therapy.

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Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial

Cited by 5 publications

References 34 publications

Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

Multi-polar stimulation of the left ventricle during cardio-resynchronisation therapy in patients with congestive heart failure: Randomised pilot study outcomes from parallel groups

Advances in Cardiac Resynchronization Therapy

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