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Randomized Controlled Trial
. 2022 Mar;63(2):399-407.
doi: 10.1007/s10840-020-00928-2. Epub 2021 Jun 22.

Long-term reverse remodeling and clinical improvement by MultiPoint Pacing in a randomized, international, Middle Eastern heart failure study

Abdulmohsen Almusaad  1 , Raed Sweidan  2 , Haitham Alanazi  3 , Abdelrahman Jamiel  3 , Fayez Bokhari  2 , Yahya Al Hebaishi  4 , Ahmed Al Fagih  4 , Najib Alrawahi  5 , Amjad Al-Mandalawi  6 , Mohamed Hashim  7 , Bandar Al Ghamdi  8 , Mohammad Amin  9 , Mohamed Elmaghawry  10 , Naeem Al Shoaibi  11 , Antonio Sorgente  12 , Maria Loricchio  13 , Ghaliah AlMohani  5 , Ismail Al Abri  5 , Edmon Benjamin  6 , Nazar Sudan  7 , Alexandre Chami  14 , Nima Badie  15 , Mohammed Sayed  10 , Ahmad Hersi  16
Affiliations
Randomized Controlled Trial

Long-term reverse remodeling and clinical improvement by MultiPoint Pacing in a randomized, international, Middle Eastern heart failure study

Abdulmohsen Almusaad et al. J Interv Card Electrophysiol. 2022 Mar.

Abstract

Purpose: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing, MPP) has been shown to improve CRT response, although MPP response using automated pacing vector programming has not been demonstrated in the Middle East. The purpose of this study was to compare the impact of MPP to conventional biventricular pacing (BiV) using echocardiographic and clinical changes at 6-month post-implant.

Methods: This prospective, randomized study was conducted at 13 Middle Eastern centers. After de novo CRT-D implant (Abbott Unify Quadra MP™ or Quadra Assura MP™) with quadripolar LV lead (Abbott Quartet™), patients were randomized to either BiV or MPP therapy. In BiV patients, the LV pacing vector was selected per standard practice; in MPP patients, the two LV pacing vectors were selected automatically using VectSelect. CRT response was defined at 6-month post-implant by a reduction in LV end-systolic volume (ESV) ≥ 15%.

Results: One hundred and forty-two patients (61 years old, 68% male, NYHA class II/III/IV 19%/75%/6%, 33% ischemic, 57% hypertension, 52% diabetes, 158 ms QRS, 25.8% ejection fraction [EF]) were randomized to either BiV (N = 69) or MPP (N = 73). After 6 months, MPP vs. BiV patients experienced greater ESV reduction (25.0% vs. 15.3%, P = 0.08), greater EF improvement (11.9% vs. 8.6%, P = 0.36), significantly greater ESV response rate (68.5% vs. 50.7%, P = 0.04), and significantly greater NYHA class improvement rate (80.8% vs. 60.3%, P = 0.01).

Conclusions: With MPP and automatic LV vector selection, more CRT patients in the Middle East experienced reverse remodeling and clinical improvement relative to conventional BiV pacing.

Keywords: Cardiac resynchronization therapy; Heart failure; MultiPoint Pacing; Reverse remodeling.

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Conflict of interest statement

Najib Al Rawahi, Fayez Bokhari, Raed Sweidan, Ahmed Al Fagih, Yahya Al Hebaishi, Ahmed Al Fagih, Ahmad Hersi, Naeem Al Shoaibi, and Maria Loricchio received research grants and/or consultancy fees from Abbott. Alexandre Chami and Nima Badie are employees of Abbott.

Figures

Fig. 1
Fig. 1
Distribution of implant locations for right atrial (RA), right ventricular (RV), and left ventricular (LV) leads (base-apex, anterior-posterior), as percent of all patients.
Fig. 2
Fig. 2
Distribution left ventricular (LV) pacing vector cathodes for biventricular pacing (BiV, left) and MultiPoint Pacing (MPP, right) groups. D1/M2/M3/P4 cathodes correspond to distal tip 1, mid 2, mid 3, proximal 4
Fig. 3
Fig. 3
End-systolic volume (ESV) response distribution (top), detailed ESV response distribution (middle), and end-systolic volume + ejection fraction (ESV+EF) response distribution (bottom) for biventricular (BiV) and MultiPoint Pacing (MPP) patients
Fig. 4
Fig. 4
End-systolic volume reduction (ΔESV, left), ejection fraction improvement (ΔEF, center), and QRS duration reduction (ΔQRSd, right) for biventricular (BiV) and MultiPoint Pacing (MPP) patients after 6 months
Fig. 5
Fig. 5
Distribution of changes in NYHA functional class for biventricular (BiV) and MultiPoint Pacing (MPP) patients after 6 months
Fig. 6
Fig. 6
Impact of baseline characteristics on end-systolic volume (ESV) responder rate odds ratio (OR) for biventricular (BiV) and MultiPoint Pacing (MPP) patients, as evaluated by binomial regression
See this image and copyright information in PMC

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