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. 2023 Apr;53(4):e13935.
doi: 10.1111/eci.13935. Epub 2022 Dec 29.

Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III

Joaquín Osca  1 , Jaume Francisco-Pascual  2 , Javier Martínez-Basterra  3 , Juan Gabriel Martínez  4 , Hipólito Reis  5 , Mario Oliveira  6 , Bieito Campos  7 , Javier Balaguer  8 , Jerónimo Rubio  9 , Ricardo Pavón-Jiménez  10 , Julio Hernández  11 , Jose Miguel Ormaetxe  12 , Jose Luis Zamorano  13 , Pilar Santamaría  14 , Javier Alzueta  15
Affiliations

Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III

Joaquín Osca et al. Eur J Clin Invest. 2023 Apr.

Abstract

Background: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate.

Aim: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant.

Methods: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort.

Results: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%.

Conclusions: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.

Keywords: cardiac resynchronization therapy; dyssynchrony; heart failure; multipoint pacing; outcomes.

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References

REFERENCES

    1. Bristow MR, Saxon LA, Boehmer J, et al. Comparison of medical therapy, pacing and defibrillation in heart failure (COMPANION) investigators. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New Eng J Med. 2008;350:2140-2150.
    1. Cleland JG, Daubert JC, Erdmann E, et al. Cardiac resynchronization study (CARE-HF) investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. New Eng J Med. 2005;352:1539-1549.
    1. Ypenburg C, van Bommel RJ, Borleffs CJ, et al. Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up. J Am Coll Cardiol. 2009;53:483-490.
    1. Schuster I, Habib G, Jego C, et al. Diastolic asynchrony is more frequent than systolic asynchrony in dilated cardiomyopathy and is less improved by cardiac resynchronization therapy. J Am Coll Cardiol. 2005;46:2250-2257.
    1. Thibault B, Dubuc M, Khairy P, et al. Acute hemodynamic comparison of multisite and biventricular pacing with a quadripolar left ventricular lead. Europace. 2013;15:984-991.