Service de Cardiologie et Maladies Vasculaires, Université de Rennes I, CICIT 804, CHU Pontchaillou Rennes, 2, rue Henri le Guilloux 35033 Rennes Cédex 09, Rennes 35033, France.
Departement of Cardiology, University of Geneva, Geneva, Switzerland.
Europace. 2023 Oct 5;25(10). doi: 10.1093/europace/euad294.
To assess the impact of MultiPoint™ Pacing (MPP) in cardiac resynchronization therapy (CRT) non-responders after 6 months of standard biventricular pacing (BiVP).
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.
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.
评估 MultiPoint™ 起搏（MPP）对标准双心室起搏（BiVP）后 6 个月心脏再同步治疗（CRT）无应答者的影响。
该试验纳入了 5850 名计划接受 CRT 装置的患者。超声心动图核心实验室在植入前和 BiVP 后 6 个月评估 CRT 反应；BiVP 无反应定义为左心室收缩末期容积（LVESV）相对减少<15%。超声心动图无应答者以 1:1 的比例随机分为 MPP 组（541 例）或继续 BiVP 组（570 例），再接受 6 个月治疗，并评估 CRT 反应的转化率。随机分组时两组患者的特征具有可比性。在 MPP 组中，有 29.4%的无应答患者对 CRT 治疗有反应，在 BiVP 组中这一比例为 30.4%（P=0.743）。在第一个阶段，发现两组左心室起搏部位之间的间距≥30mm（MPP-AS）的患者为潜在的有益亚组，其转化率无显著差异。
我们的试验表明，在最初 6 个月内对 CRT 无反应的患者中，约有 30%在接下来的 6 个月内经历了显著的逆向重构。这一发现表明，在相当一部分患者中，CRT 获益可能延迟或缓慢递增，而 CRT 应答者的比例可能高于短期/中期研究中所描述的比例。即使在 MPP-AS 患者中，MPP 也不能改善 BiVP 无应答者的 CRT 反应。
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