Improving cardiac resynchronization therapy response with multipoint left ventricular pacing: Twelve-month follow-up study

Carlo Pappone, Žarko Ćalović, Gabriele Vicedomini, Amarild Cuko, Luke C. McSpadden, Kyungmoo Ryu, Caroline D. Jordan, Enrico Romano, Mario Baldi, Massimo Saviano, Alessia Pappone, Raffaele Vitale, Concetto Catalano, Cristiano Ciaccio, Luigi Giannelli, Bogdan Ionescu, Andrea Petretta, Nikolaos Fragakis, Angelica Fundaliotis, Luigi TavazziVincenzo Santinelli

Research output: Contribution to journalArticlepeer-review

Abstract

Background Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], St. Jude Medical) improves acute LV function and LV reverse remodeling at 3 months. Objective The purpose of this study was to test the hypothesis that MPP can also improve LV function at 12 months. Methods Consecutive patients receiving a CRT implant (Unify Quadra MP™ or Quadra Assura MP™ CRT-D and Quartet™ LV lead, St. Jude Medical) were randomized to receive pressure-volume (PV) loop optimized biventricular pacing with either conventional cardiac resynchronization therapy (CONV) or MPP. CRT response was defined by a reduction in end-systolic volume (ESV) 15% relative to BASELINE as determined by a blinded observer and alive status. Results Forty-four patients (New York Heart Association class III, ejection fraction [EF] 29% ± 6%, QRS 152 ± 17 ms) were enrolled and randomized to either CONV (N = 22) or MPP (N = 22). During the observation period, 2 patients died of noncardiac causes and 2 patients were lost to follow-up. After 12 months, 12 of 21 patients (57%) in the CONV group and 16 of 21 patients (76%) in the MPP group were classified as CRT responders (P =.33). ESV reduction and EF increase relative to BASELINE were significantly greater with MPP than with CONV (ESV: median -25%, interquartile range [IQR] [-39% to -20%] vs median -18%, IQR [-25% to -2%], P =.03; EF: median +15%, IQR [8% to 20%] vs median +5%, IQR [-1% to 8%], P

Original languageEnglish
Pages (from-to)1250-1258
Number of pages9
JournalHeart Rhythm
Volume12
Issue number6
DOIs
Publication statusPublished - Jun 1 2015

Keywords

  • Abbreviations CONV conventional cardiac resynchronization therapy
  • CRT cardiac resynchronization therapy
  • CS coronary sinus
  • dP/dt rate of pressure change
  • EF ejection fraction
  • ESV end-systolic volume
  • IQR interquartile range
  • LBBB left bundle branch block
  • LV left ventricle
  • MPP MultiPoint<sup>TM</sup> Pacing
  • NYHA New York Heart Association
  • PV pressure-volume
  • RV right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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