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

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:

Totally, 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%.

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.

• Authors: 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, Javier Alzueta
• Journal: European journal of clinical investigation (Eur J Clin Invest) Vol. 53 Issue 4 Pg. e13935 (Apr 2023) ISSN: 1365-2362 [Electronic] England
• PMID: 36504276 (Publication Type: Journal Article)
• Copyright: © 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Topics

• Humans
• Cardiac Resynchronization Therapy
• Prospective Studies
• Ventricular Function, Left (physiology)
• Stroke Volume (physiology)
• Treatment Outcome
• Cardiac Resynchronization Therapy Devices
• Heart Failure