Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco", Milano, Italy.
Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Italy.
J Cardiovasc Electrophysiol. 2019 Dec;30(12):2885-2891. doi: 10.1111/jce.14254. Epub 2019 Nov 5.
Multipoint pacing (MPP) may improve clinical outcomes in patients with cardiac resynchronization therapy defibrillators (CRT-D), but its impact on battery longevity in a real-world population has not been investigated in large trials.
Compare projected battery longevity in CRT-D patients with and without MPP during long-term follow-up.
The Italian registry on multipoint left ventricular pacing (IRON-MPP) is a prospective, multicenter registry of patients implanted with MPP-capable CRT-D devices. Projected battery longevity during follow-up was compared for patients with MPP (MPP ON) vs single-site (MPP OFF) left ventricular pacing at CRT-D implantation. A sub-analysis excluded crossover patients with MPP activation or deactivation occurring after implantation. A second sub-analysis excluded patients with a right or left ventricular pacing amplitude >2.5 V.
Out of 237 CRT-D patients (71 ± 9 years, 81% male) followed for 1.9 ± 0.8 years, 102 (43%) had MPP ON at implantation. Programmed atrial and ventricular outputs and percentage of pacing were similar between groups. MPP was associated with a 0.44 years reduction in projected battery longevity (P = .03) during long-term follow-up. Results were similar for the first and second sub-analyses, with a 0.57 years (P < .001) and 0.71 years (P < .001) reduction in projected longevity, respectively.
In this long-term real-world registry, early MPP activation is associated with less than a 1-year reduction in projected battery life compared to single-site biventricular pacing.
多点起搏（MPP）可能改善心脏再同步治疗除颤器（CRT-D）患者的临床转归，但在大型试验中尚未研究其对电池寿命的影响。
比较长期随访中具有和不具有 MPP 的 CRT-D 患者的预计电池寿命。
意大利多点左心室起搏（IRON-MPP）注册研究是一项前瞻性、多中心注册研究，纳入了植入 MPP 功能 CRT-D 设备的患者。在随访期间，比较了具有 MPP（MPP ON）和单部位（MPP OFF）左心室起搏的 CRT-D 植入患者的预计电池寿命。亚分析排除了 MPP 激活或失活发生在植入后的交叉患者。第二次亚分析排除了右心室或左心室起搏幅度>2.5V 的患者。
在 237 名 CRT-D 患者（71±9 岁，81%为男性）中，102 名（43%）在植入时具有 MPP ON。两组之间程控的心房和心室输出以及起搏百分比相似。与长期随访期间的预计电池寿命相比，MPP 与 0.44 年的电池寿命缩短相关（P=0.03）。首次和第二次亚分析结果相似，与单部位双心室起搏相比，预计寿命分别缩短了 0.57 年（P<0.001）和 0.71 年（P<0.001）。
在这项长期真实世界注册研究中，与单部位双心室起搏相比，早期 MPP 激活与预计电池寿命缩短不到 1 年相关。
