Key result
MPP yields a highly heterogeneous ~8% greater LVESV reduction than BiV pacing.
Why the study?
MultiPoint Pacing may enhance CRT response, but randomized evidence comparing it to conventional biventricular pacing remains inconsistent in patients with heart failure and reduced ejection fraction.
Meta-Analysis (n=1,766)
Yes
Mean Difference: 7.57 (95% CI 0.76–14.39)
p-value: p=0.03
Systematic review finds improved responses with multipoint pacing in heart failure patients, suggesting targeted use.
BACKGROUND: MultiPoint Pacing (MPP) may enhance the clinical and echocardiographic response to Cardiac Resynchronization Therapy (CRT), but randomized evidence remains inconsistent. The objective of this study is to compare the efficacy and safety of MPP versus conventional biventricular (BiV) pacing in patients with heart failure and reduced ejection fraction. METHODS: We conducted a PROSPERO-registered (CRD420251033856) systematic review and meta-analysis of randomized controlled trials evaluating MPP versus BiV pacing. Outcomes included LVESV reduction, LVEF improvement, clinical response rate, super-response rate, and conversion to non-responder. Data were synthesized using random-effects models, and certainty was assessed with GRADE. RESULTS: Six RCTs (n = 1,766) were included. MPP significantly improved LVEF (MD 5.16%, 95% CI 3.17-7.15; P < 0.0001), clinical response rate (RR 1.35, 95% CI 1.18-1.55; P < 0.0001), and super-response rate (RR 1.54, 95% CI 1.15-2.06; P = 0.004). The pooled LVESV analysis showed a nominally significant benefit with MPP, but this was accompanied by substantial heterogeneity and a prediction interval crossing zero, limiting confidence in a universal effect; the benefit appeared more consistent in CRT-naïve patients. No significant improvement was observed in non-responder conversion (RR 0.99). Overall certainty ranged from very low to moderate. CONCLUSION: Multipoint pacing is associated with signals of improved left ventricular reverse remodeling and higher clinical response rates compared with conventional biventricular pacing. However, the high heterogeneity and a 95% prediction interval crossing zero for LVESV reduction indicate that this effect is not consistent across all populations. MPP provides clinically meaningful benefits primarily in selected patient subgroups-particularly in CRT-naïve and responder populations-rather than serving as a universal rescue strategy for established non-responders.
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Saeed et al. (2026) conducted a meta-analysis in Heart failure with reduced ejection fraction (n=1,766). MultiPoint Pacing (MPP) vs. Conventional biventricular (BiV) pacing was evaluated on Percentage reduction in Left Ventricular end-Systolic Volume (LVESV) (MD 7.57%, 95% CI 0.76-14.39, p=0.03). Multipoint pacing showed a nominally significant 7.57% greater reduction in left ventricular end-systolic volume compared to biventricular pacing, though the effect was highly heterogeneous across populations.
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