title: Improving cardiac resynchronization therapy response with multipoint left ventricular pacing: Twelve-month follow-up study.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], St. Jude Medical) improves acute LV function and LV reverse remodeling at 3 months.
  
  
  OBJECTIVE
  The purpose of this study was to test the hypothesis that MPP can also improve LV function at 12 months.
  
  
  METHODS
  Consecutive patients receiving a CRT implant (Unify Quadra MP™ or Quadra Assura MP™ CRT-D and Quartet™ LV lead, St. Jude Medical) were randomized to receive pressure-volume (PV) loop optimized biventricular pacing with either conventional cardiac resynchronization therapy (CONV) or MPP. CRT response was defined by a reduction in end-systolic volume (ESV) ≥15% relative to BASELINE as determined by a blinded observer and alive status.
  
  
  RESULTS
  Forty-four patients (New York Heart Association class III, ejection fraction [EF] 29% ± 6%, QRS 152 ± 17 ms) were enrolled and randomized to either CONV (N = 22) or MPP (N = 22). During the observation period, 2 patients died of noncardiac causes and 2 patients were lost to follow-up. After 12 months, 12 of 21 patients (57%) in the CONV group and 16 of 21 patients (76%) in the MPP group were classified as CRT responders (P = .33). ESV reduction and EF increase relative to BASELINE were significantly greater with MPP than with CONV (ESV: median -25%, interquartile range [IQR] [-39% to -20%] vs median -18%, IQR [-25% to -2%], P = .03; EF: median +15%, IQR [8% to 20%] vs median +5%, IQR [-1% to 8%], P <.001).
  
  
  CONCLUSIONS
  Sustaining the trend observed 3 months postimplant, PV loop-guided multipoint LV pacing resulted in greater LV reverse remodeling and increased LV function at 12 months compared to PV loop-guided conventional CRT.
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. Electronic address: cpappone@gvmnet.it.
authors: Carlo
authors: C
authors: Pappone
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Žarko
authors: Ž
authors: Ćalović
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Gabriele
authors: G
authors: Vicedomini
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Amarild
authors: A
authors: Cuko
authors: St. Jude Medical, Sylmar, California.
authors: Luke C
authors: LC
authors: McSpadden
authors: St. Jude Medical, Sylmar, California.
authors: Kyungmoo
authors: K
authors: Ryu
authors: St. Jude Medical, Sylmar, California.
authors: Caroline D
authors: CD
authors: Jordan
authors: St. Jude Medical, Milan, Italy.
authors: Enrico
authors: E
authors: Romano
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Mario
authors: M
authors: Baldi
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Massimo
authors: M
authors: Saviano
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Alessia
authors: A
authors: Pappone
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Raffaele
authors: R
authors: Vitale
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Concetto
authors: C
authors: Catalano
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Cristiano
authors: C
authors: Ciaccio
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Luigi
authors: L
authors: Giannelli
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Bogdan
authors: B
authors: Ionescu
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Andrea
authors: A
authors: Petretta
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Nikolaos
authors: N
authors: Fragakis
authors: Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy.
authors: Angelica
authors: A
authors: Fundaliotis
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Luigi
authors: L
authors: Tavazzi
authors: Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
authors: Vincenzo
authors: V
authors: Santinelli
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D002304:Cardiac Pacing, Artificial / Q000379:methods; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D004452:Echocardiography; D005500:Follow-Up Studies; D006352:Heart Ventricles; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Cardiac resynchronization therapy; Cardiac resynchronization therapy response; Heart failure; Multipoint pacing