Safety and Efficacy of Multipoint Pacing in Cardiac Resynchronization Therapy

Abstract

MPP is safe and effective for treating heart failure. The study met the pre-specified hypothesis that response to MPP is noninferior to Bi-V pacing with a quadripolar left ventricular lead. (MultiPoint Pacing IDE Study [MPP IDE]; NCT01786993).

Multipoint pacing improves peripheral hemodynamic response: Noninvasive assessment using radial artery tonometry

“…This finding is in agreement with our recent observation that MPP pacing vectors based on maximizing anatomical spacing between LV1 and LV2 cathodes and with 5 ms LV1‐LV2 delay resulted in the best dP/dt max and stroke work response more often than an electrical delay‐based pacing vector selection method or 40 ms LV1‐LV2 delay . The results from the randomized MPP IDE study also reported similar findings that CRT response rate was greatest at 87% when MPP was programmed with cathode spacing ≥30 mm and 5 ms LV1‐LV2 delay …”

“…15 The results from the randomized MPP IDE study also reported similar findings that CRT response rate was greatest at 87% when MPP was programmed with cathode spacing ≥30 mm and 5 ms LV1-LV2 delay. 16 Finally, QuickOpt TM was used in this study to select the VV delay in the CONV group and two out of the five pacing configurations in the MPP group. QuickOpt TM is an automatic, built-in tool in the device that uses the IEGM and intrinsic intracardiac conduction delays to help the physician in selecting AV and VV delays.…”

Fracture of an epicardial left ventricular lead implanted at open‐heart surgery in anticipation of future need for cardiac resynchronization therapy

“…The response to CRT using a transvenous approach with reduced morbidity and mortality is well established . Optimal transvenous LV lead placement is limited by the variable coronary venous anatomy, but contemporary transvenous lead delivery systems and use of quadripolar leads yield implant success rates of up to 97% with postoperative possibility of vector optimization and multipoint pacing to optimize CRT response . The alternate option is to surgically place an epicardial LV lead.…”

“…1,2 Optimal transvenous LV lead placement is limited by the variable coronary venous anatomy, but contemporary transvenous lead delivery systems and use of quadripolar leads yield implant success rates of up to 97% with postoperative possibility of vector optimization and multipoint pacing to optimize CRT response. 7 The alternate option is to surgically place an epicardial LV lead. This can be performed at concomitant openheart surgery or by less invasive video-assisted thoracoscopy and left-lateral mini-thoracotomy.…”

Cardiac resynchronization therapy improves survival in selected patients with moderately impaired ejection fraction — the importance of left ventricular remodelling

“…Early clinical trials assessed response to CRT relatively early, typically at 3 to 6 months. However, multipoint pacing studies have demonstrated late remodelling among patients initially considered ‘non‐responders’ in those randomized to standard biventricular pacing . This late remodelling was directly observed in REVERSE, where LVEF improvement was maximal at 2 years .…”