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.

中文翻译：

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MultiPoint Pacing 在一项随机、国际、中东心力衰竭研究中的长期反向重塑和临床改善

目的

使用多点左心室 (LV) 起搏 (MultiPoint™ Pacing, MPP) 的心脏再同步化治疗 (CRT) 已被证明可以改善 CRT 反应，尽管在中东尚未证明使用自动起搏矢量编程的 MPP 反应。本研究的目的是使用植入后 6 个月的超声心动图和临床变化比较 MPP 与传统双心室起搏 (BiV) 的影响。

方法

这项前瞻性随机研究在 13 个中东中心进行。在使用四极 LV 导联 (Abbott Quartet™) 从头 CRT-D 植入物（Abbott Unify Quadra MP™ 或 Quadra Assura MP™）后，患者随机接受 BiV 或 MPP 治疗。在 BiV 患者中，根据标准做法选择 LV 起搏向量；在 MPP 患者中，使用 VectSelect 自动选择两个 LV 起搏向量。CRT 反应在植入后 6 个月时定义为 LV 收缩末期容积 (ESV) 减少 ≥ 15%。

结果

142 名患者（61 岁，68% 男性，NYHA II/III/IV 级 19%/75%/6%，33% 缺血，57% 高血压，52% 糖尿病，158 ms QRS，25.8%射血分数 [EF]) 被随机分配到 BiV ( N = 69) 或 MPP ( N = 73)。6 个月后，MPP 与 BiV 患者的 ESV 降低幅度更大（25.0% 对 15.3%，P = 0.08），EF 改善更大（11.9% 对 8.6%，P = 0.36），ESV 反应率显着提高（68.5%与 50.7%，P = 0.04），以及显着更高的 NYHA 等级改进率（80.8% 与 60.3%，P = 0.01）。

结论

相对于传统的 BiV 起搏，通过 MPP 和自动 LV 矢量选择，中东更多的 CRT 患者经历了反向重塑和临床改善。