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

Abdulmohsen Almusaad,N Sudan ,Haitham Alanazi,Mohamed Elmaghawry,Amjad Al-Mandalawi,Antonio Sorgente,Mohammed E Sayed ,Raed Sweidan,Yahya Al Hebaishi,Fayez Bokhari,Edmon Benjamin,Naeem Al Shoaibi,Ismail Al Abri,Bandar Al‐Ghamdi ,Nima Badie,Maria Luisa Loricchio ,Alexandre Chami,Mohammad Al Amin ,Abdelrahman Jamiel,Ghaliah Al-Mohani ,Ahmed Al Fagih,Mohamed Shafik Hashim ,Najib Al-Rawahi ,Ahmad Hersi

doi:10.1007/s10840-020-00928-2

Abstract

PurposeCardiac 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.MethodsThis 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%.ResultsOne 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).ConclusionsWith MPP and automatic LV vector selection, more CRT patients in the Middle East experienced reverse remodeling and clinical improvement relative to conventional BiV pacing.

Highlights

Cardiac resynchronization therapy (CRT) provides significant long-term benefits to patients with moderate to severe heart failure (HF), prolonged QRS duration, and reduced ejection fraction (EF) [1,2,3]
One hundred and eighty-two (182) patients were enrolled in 13 centers across 7 Middle Eastern countries
Due to the added programming flexibility of a second left ventricular (LV) vector, most MPP devices are left unoptimized with out-of-the-box settings

Summary

Introduction

Cardiac resynchronization therapy (CRT) provides significant long-term benefits to patients with moderate to severe heart failure (HF), prolonged QRS duration, and reduced ejection fraction (EF) [1,2,3]. Multipoint left ventricular (LV) pacing (MultiPointTM Pacing [MPP], Abbott, Sylmar, CA), stimulating two LV sites on a quadripolar lead, is one key strategy to improve CRT response over conventional biventricular (BiV) pacing. In MPP clinical studies to date, selection of the two LV pacing vectors (each with up to 14 LV cathode-anode combinations) has either (a) been guided by manual, in-clinic electrical or hemodynamic measurements, or (b) left entirely to the discretion of the physician. The current study is the first randomized comparison of MPP and BiV in the Middle East that relied solely on one automated, programmer-based tool (VectSelectTM, Abbott) which provides MPP LV pacing vector recommendations that are both patient-specific and require minimal physician input

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