Multipoint pacing via a quadripolar left-ventricular lead: preliminary results from the Italian registry on multipoint left-ventricular pacing in cardiac resynchronization therapy (IRON-MPP).

Giovanni B Forleo, Luca Santini, Massimo Giammaria, Domenico Potenza, Antonio Curnis, Vito Calabrese, Danilo Ricciardi, Carlo D'agostino, Pasquale Notarstefano, Valentina Ribatti, Giovanni Morani, Massimo Mantica, Luigi Di Biase, Emanuele Bertaglia, Leonardo Calò, Francesco Zanon

Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2018;19(7):1170-1177

PMID: 27189954

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Abstract

AIMS

This registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices.

METHODS AND RESULTS

A total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to 'ON' in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to 'ON' (n = 94) or 'OFF' (n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly (P < 0.001).

CONCLUSION

This study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF.

CLINICAL TRIAL REGISTRATION

http://www.clinicaltrial.gov/. Unique identifier: NCT02606071.

Address: Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy.; Ospedale Maria Vittoria, Torino, Italy.; Ospedale Casa Sollievo Della Sofferenza, S.Giovanni Rotondo, Italy.; Ospedali Civili di Brescia, Brescia, Italy.; Policlinico Universitario Campus Bio-Medico, Rome, Italy.; Ospedale di Venere, Bari, Italy.; Ospedale S. Donato, Arezzo, Italy.; Azienda Ospedaliera Universitaria Verona, Verona, Italy.; Policlinico S. Ambrogio, Milan, Italy.; Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA.; Department of Cardiology, University of Foggia, Foggia, Italy.; Azienda Ospedaliera Universitaria, Padova, Italy.; Policlinico Casilino, Roma, Italy.

DOI: 10.1093/europace/euw094