• Joaquín Osca, Jaume Francisco-Pascual, Javier Martínez-Basterra, Juan Gabriel Martínez, Hipólito Reis, Mario Oliveira, Bieito Campos, Javier Balaguer, Jerónimo Rubio, Ricardo Pavón-Jiménez, Julio Hernández, Jose Miguel Ormaetxe, Jose Luis Zamorano, Pilar Santamaría, and Javier Alzueta.
• Hospital Universitari i Politecnic La Fe, Valencia, Spain.
• Eur. J. Clin. Invest. 2023 Apr 1; 53 (4): e13935e13935.

BackgroundAlthough cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate.AimTo assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant.MethodsThis was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort.ResultsTotally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%.ConclusionsEarly activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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