What does this research mean for the field?

Q: What does this research mean for the field?

Multipoint pacing (MPP) in cardiac resynchronization therapy significantly improves functional class and acute hemodynamic parameters compared to traditional biventricular pacing, but does not improve prognostic indices or left ventricular end-systolic volume (LVESV) and reduces projected battery longevity. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 1, 2021Heart Rhythm O2Open Access

Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

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Why the study?

Multipoint pacing aims to improve response rates to cardiac resynchronization therapy, but its effectiveness compared to traditional biventricular pacing required evaluation across clinical studies.

Does multipoint pacing improve hemodynamic, clinical, and prognostic parameters compared to traditional biventricular pacing in heart failure patients?

Structured PICO

Does multipoint pacing improve hemodynamic, clinical, and prognostic parameters compared to traditional biventricular pacing in heart failure patients?

Population

Heart failure patients undergoing cardiac resynchronization therapy

Intervention

Multipoint pacing (MPP) via quadripolar lead

Comparator

Traditional biventricular pacing (BiV)

Outcome

Hemodynamic, clinical, and prognostic parameters (including functional class, acute hemodynamic parameters, prognostic indices, LVESV, and battery longevity)

Multipoint pacing improves functional class and acute hemodynamics compared to traditional biventricular pacing, but does not improve prognostic indices or LVESV and reduces battery longevity.

Implication

MPP lacks prognostic benefit versus BiV and reduces battery longevity; challenges routine adoption and leaves outcome trials open.

Abstract

BACKGROUND: Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) therapy, as it has reduced mortality and morbidity and has shown improvement in functional capacity. Multipoint pacing (MPP) is a way of configuring CRT with the aim to improve the percentage of patients who respond to CRT. OBJECTIVE: To demonstrate the effectiveness of the MPP compared to traditional biventricular pacing (BiV). METHODS: We performed a systematic review and meta-analysis according to PRISMA guidelines of studies in which MPP vs BiV strategy were compared. RESULTS: = .00007) with respect to BiV. CONCLUSION: MPP significantly improves functional class and acute hemodynamic parameters with respect to BiV. Prognostic indices and LVESV are not significantly influenced by MPP. MPP is associated with a significant reduction in projected battery longevity.