Key result
MultiPoint Pacing did not significantly improve the conversion rate to echocardiographic response compared to continued biventricular pacing in CRT non-responders (29.4% vs 30.4%; P=0.743).
Why the study?
To assess the impact of MultiPoint Pacing in cardiac resynchronization therapy non-responders after 6 months of standard biventricular pacing.
Does MultiPoint Pacing improve the conversion rate to echocardiographic response in patients who are non-responders to 6 months of standard biventricular pacing?
RCT (n=1,111)
1:1
Does MultiPoint Pacing improve the conversion rate to echocardiographic response in patients who are non-responders to 6 months of standard biventricular pacing?
Absolute Event Rate: 29.4% vs 30.4%
p-value: p=0.743
MultiPoint Pacing does not improve CRT response in initial non-responders, but approximately 30% of non-responders at 6 months will experience significant reverse remodeling with continued standard biventricular pacing.
Does not support MPP over BiVP in CRT non-responders; leaves open need for novel strategies to boost response rates.
AIMS: To assess the impact of MultiPoint™ Pacing (MPP) in cardiac resynchronization therapy (CRT) non-responders after 6 months of standard biventricular pacing (BiVP). METHODS AND RESULTS: The trial enrolled 5850 patients who planned to receive a CRT device. The echocardiography core laboratory assessed CRT response before implant and after 6 months of BiVP; non-response to BiVP was defined as <15% relative reduction in left ventricular end-systolic volume (LVESV). Echocardiographic non-responders were randomized in a 1:1 ratio to receive MPP (541 patients) or continued BiVP (570 patients) for an additional 6 months and evaluated the conversion rate to the echocardiographic response. The characteristics of both groups at randomization were comparable. The percentage of non-responder patients who became responders to CRT therapy was 29.4% in the MPP arm and 30.4% in the BIVP arm (P = 0.743). In patients with ≥30 mm spacing between the two left ventricular pacing sites (MPP-AS), identified during the first phase as a potential beneficial subgroup, no significant difference in the conversion rate was observed. CONCLUSION: Our trial shows that ∼30% of patients, who do not respond to CRT in the first 6 months, experience significant reverse remodelling in the following 6 months. This finding suggests that CRT benefit may be delayed or slowly incremental in a relevant proportion of patients and that the percentage of CRT responders may be higher than what has been described in short-/middle-term studies. MultiPoint™ Pacing does not improve CRT response in non-responders to BiVP, even with MPP-AS.
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Leclercq et al. (2023) conducted an RCT in Cardiac resynchronization therapy (CRT) non-responders (n=1,111). MultiPoint Pacing (MPP) vs. Continued standard biventricular pacing (BiVP) was evaluated on Conversion rate to echocardiographic response (p=0.743). MultiPoint Pacing did not significantly improve the conversion rate to echocardiographic response compared to continued biventricular pacing in CRT non-responders (29.4% vs 30.4%; P=0.743).
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