CRT Response Rate With MultiPoint Pacing Study

Sep 24, 2019
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Authors:
Leclerq C, Burri H, Curnis A, et al.
Citation:
Cardiac Resynchronization Therapy Non-Responder to Responder Conversion Rate in the More Response to Cardiac Resynchronization Therapy With MultiPoint Pacing (MORE-CRT MPP) Study: Results From Phase I. Eur Heart J 2019;40:2979-2987.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does MultiPoint Pacing (MPP) improve the response rate to cardiac resynchronization therapy (CRT)?

Methods:

A CRT system capable of MPP was implanted in 1,921 patients (mean ejection fraction 26%) and programmed for biventricular pacing. A nonresponse to CRT was defined as a <15% reduction in left ventricular end-systolic volume at 6 months. Nonresponders to conventional CRT were randomly assigned to MPP (n = 236) or continued biventricular pacing (n = 231) and followed for 6 more months.

Results:

The conversion rate of nonresponders to responders did not differ significantly between the MPP group (31.8%) and the biventricular pacing group (33.8%). Within the MPP group, patients with the widest anatomical separation between pacing points and the shortest timing delays had a higher conversion rate (45.6%) than patients in whom the MPP settings were programmed according to physician discretion (33.8%).

Conclusions:

The authors concluded that MPP does not improve the response rate to CRT.

Perspective:

A quadripolar lead implanted in a branch of the coronary sinus enables MPP. The rationale of MPP is to reduce the left ventricular activation time. While some studies have shown acute and chronic improvements in hemodynamic parameters with MPP, the present study is the first large-scale randomized clinical trial to investigate the long-term effect of MPP. Although the results indicate no overall incremental benefit from MPP, it is possible that MPP programmed according to specific parameters may be helpful. This is being evaluated in phase II of the study.

Keywords: Arrhythmias, Cardiac, Cardiac Resynchronization Therapy, Coronary Sinus, Heart Failure, Heart Ventricles, Hemodynamics, Pacemaker, Artificial, Secondary Prevention


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