Multipoint left ventricular pacing with large anatomical separation improves reverse remodeling and response to cardiac resynchronization therapy in responders and non-responders to conventional biventricular pacing

Background Multipoint pacing [Multipoint (TM) Pacing (MPP), Abbott] via a single left ventricular lead (Quartet (TM) LV lead, Abbott) improves acute left ventricular (LV) function and response to cardiac resynchronization therapy (CRT). Aim of this study was to examine additional benefits in terms of LV reverse remodeling and CRT response by activating MPP in responders and non-responders to conventional biventricular pacing (CONV). Methods 43 consecutive patients receiving CRT (Quadra Assura MP (TM), Abbott) received LV dP/dt(max) optimized CONV programming for 6 months. MPP programming with large anatomical electrode separation (> 30 mm) and basal LV1 pacing location was activated afterwards. Echocardiographic and clinical parameters were obtained at baseline, 6- and 12-month follow-up (FU). The response was defined as an improvement of LVESV >= 15% and super-response as improvement >= 30% relative to baseline. Results 41 patients completed FU (one died of non-cardiac cause and one was lost to FU) and after 6 months CONV, 26 patients (63%) were classified as CRT responders. With MPP, the response rate increased to 90% (p < 0.001). Super-response also improved significantly with MPP compared to CONV (71% vs. 22%; p < 0.005). LV reverse remodeling in terms of LVESV improved significantly with MPP compared to CONV (79 +/- 45 ml vs. 103 +/- 64 ml; p < 0.001). NYHA-class only improved significantly with CONV relative to baseline (1,8 +/- 0,7 vs. 2,7 +/- 0,5; p < 0.001), but not further with MPP (1,7 +/- 0,6 vs. 1,8 +/- 0,7; p = 0.49). Conclusion Multipoint pacing significantly improves response and super-response to CRT as well as LV reverse remodeling compared to conventional biventricular pacing. [GRAPHICS] .