Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint(TM) Pacing feature activated. QUARTO III.

Autores de IIS La Fe

• Joaquín Osca Asensi

  Autor

• Julia Balaguer Guill

  Autor

• José María Rubio Rubio

  Autor

Participantes ajenos a IIS La Fe

• Francisco-Pascual, Jaume
• Martinez-Basterra, Javier
• Martinez, Juan Gabriel
• Reis, Hipolito
• Oliveira, Mario
• Campos, Bieito
• Pavon-Jimenez, Ricardo
• Hernandez, Julio
• Ormaetxe, Jose Miguel
• Zamorano, Jose Luis
• Santamaria, Pilar
• Alzueta, Javier

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

  

  Investigador Principal

  Esther Roselló Lletí

• Investigación Clínica y Traslacional en Cáncer

  

  Leader

  José Gómez Codina

• Medicina Fetal y Reproductiva

  

  Investigador Principal

  José Morales Roselló

Abstract

BACKGROUND: Although 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. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This 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. RESULTS: 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 toward 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%. CONCLUSIONS: Early 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.

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Keywords

• Cardiac Resynchronization Therapy.; Dyssynchrony.; Heart Failure; Multipoint pacing.; Outcomes.