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Randomized Controlled Trial
. 2024 Nov 1;26(11):euae259.
doi: 10.1093/europace/euae259.

Multipoint pacing is associated with improved prognosis and cardiac resynchronization therapy response: MORE-CRT MPP randomized study secondary analyses

Calò Leonardo  1 , De Ruvo Ermenegildo  1 , Kolb Christof  2 , Janmohamed Amir  3 , Marques Pedro  4 , Defaye Pascal  5 , Marquie Christelle  6 , Piot Olivier  7 , Grammatico Andrea  8 , Lee Kwangdeok  9 , Lin Wenjiao  9 , Burri Haran  10 , Sperzel Johannes  11 , Thibault Bernard  12 , Rinaldi Christopher  13 , Leclercq Christophe  14
Affiliations
Randomized Controlled Trial

Multipoint pacing is associated with improved prognosis and cardiac resynchronization therapy response: MORE-CRT MPP randomized study secondary analyses

Calò Leonardo et al. Europace. .

Erratum in

Abstract

Aims: Cardiac resynchronization therapy (CRT) via biventricular (BIV) pacing is indicated in patients with heart failure (HF), reduced ejection fraction, and prolonged QRS duration. Quadripolar leads and multipoint pacing (MPP) allow multiple left ventricle (LV) sites pacing. We aimed to assess the clinical benefit of MPP in patients who do not respond to standard BIV pacing.

Methods and results: Overall, 3724 patients were treated with standard BIV pacing. After 6 months, 1639 patients were considered as CRT non-responders (echo-measured relative reduction in LV end-systolic volume (LVESV) < 15%) and randomized to MPP or BIV. We analysed 593 randomized patients (291 MPP, 302 BIV), who had BIV pacing >97% of the time before randomization and complete 12 months of clinical and echocardiographic data. The endpoint composed of freedom from cardiac death and HF hospitalizations and by LVESV relative reduction ≥15% between randomization and 12 months occurred more frequently in MPP [96/291 (33.0%)] vs. BIV [71/302 (23.5%), P = 0.0103], which was also confirmed at multivariate analysis (hazard ratio = 1.55, 95% confidence interval = 1.02-2.34, P = 0.0402 vs. BIV). HF hospitalizations occurred less frequently in MPP [14/291 (4.81%)] vs. BIV [29/302 (9.60%), incidence rate ratio = 50%, P = 0.0245]. Selecting patients with a large (>30 ms) dispersion of interventricular electrical delay among the four LV lead dipoles, reverse remodelling was more frequent in MPP [18/51 (35.3%)] vs. BIV [11/62 (17.7%), P = 0.0335].

Conclusion: In patients who do not respond to standard CRT despite the high BIV pacing percentage, MPP is associated with lower occurrence of HF hospitalizations and higher probability of reverse LV remodelling compared with BIV pacing.

Keywords: Biventricular pacing; Cardiac resynchronization; Heart failure; MPP; Multipoint pacing; Quadripolar left ventricular pacing; Randomized controlled study.

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Conflict of interest statement

Conflict of interest: Dr Rinaldi has received research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics, EBR Systems, and MicroPort outside of the submitted work. Dr Leclercq has received honoraria from Abbott, Medtronic, Boston Scientific, Biotronik, and Livanova. Dr Burri has received institutional fellowship support and research grants from Abbott. Dr Sperzel serves as a consultant to Abbott, in addition to receiving honoraria and currently conducting research sponsored by Abbott. Dr Thibault has received research support and honoraria from Abbott and Medtronic. Dr Lee, Ms Lin. and Mr Grammatico are employees of Abbott. All remaining authors have declared no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Occurrence of cardiac death, HF hospitalizations, failed reverse remodelling, and failed CRT response.
Figure 3
Figure 3
Kaplan–Meier incidence of heart failure hospitalizations in MPP and BIV arms.
Figure 4
Figure 4
CRT response in terms of proportion of patients with LVESV relative reduction >15%, between 6 months (randomization) and 12 months of visits, as a function of interventricular electrical delay dispersion among the four LV dipoles in the randomized study population.
See this image and copyright information in PMC

References

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