Abstract 16395: Multipoint Left Ventricular Pacing Improves Acute Hemodynamics and Short-Term Outcomes in Cardiac Resynchronization Therapy: A Systematic Review
Introduction: One third of patients who meet criteria for cardiac resynchronization therapy fail to respond. Multipoint pacing of the left ventricle (MPP) has emerged as an alternative to reduce rates of non-response seen with conventional biventricular pacing (Conv-BiV).
Hypothesis: We hypothesize that MPP is associated with improved acute hemodynamics and short-term outcomes compared to Conv-BiV.
Methods: We searched MEDLINE, EMBASE, and Cochrane Library through March 2016 for prospective studies investigating the use of MPP. Outcomes were compared with weighted mean differences under the random-effects model and heterogeneity examined via Cochran Q test and I2 statistics. RevMan 5.3 was used for statistical analysis.
Results: A total of 7 studies including 155 patients with NYHA class II-IV heart failure (76% men, age 66 ±9 years, 46% ischemic etiology, EF 22.5 ±6.0%, QRS duration 162.2 ±20.5ms) undergoing placement of a quadripolar lead with MPP capabilities were included in the analysis. Subjects were initially paced via Conv-BiV and then via MPP, thereby serving as their own controls. LBBB was the most common conduction abnormality (n=107), followed by unspecified (n=19), V-pacing (n=11), IVCD (n=12), and RBBB (n=6). There were no reported deaths or complications. There was a trend for Δ dP/dtmax to be higher with MPP than Conv-BiV (2.8% [95% CI -0.3 to 6.0]; p=0.09). QRS duration was shortened by both Conv-BiV (-10ms [95% CI -19.2 to -0.8]; p=0.03) and MPP (-23.5ms [95% CI -48.9 to 1.7]; p=0.07). No statistically significant difference was noted in QRS duration with MPP when compared to Conv-BiV (-8ms [95% CI -21.0 to 5.0]; p=0.23). Furthermore, EF was significantly improved at 1-3 month follow-up with Conv-BiV (5.4% [95% CI 2.3 to 8.4]; p<0.001) and MPP (11.6% [95% CI 9.9 to 13.3]; p<0.001; intergroup comparison p<0.001).
Conclusions: Pooled analysis indicates that MPP is not only safe and feasible, but performs better than Conv-BiV with significant improvement in EF during short-term follow-up. Larger prospective studies are needed to establish whether long-term outcomes are improved.
Author Disclosures: R. Mendirichaga: None. L.K. Lambrakos: None. R. Cardoso: None. A. Rodriguez: None. C. Healy: None. J.F. Viles-Gonzalez: None. R.D. Mitrani: None. J.J. Goldberger: None.
- © 2016 by American Heart Association, Inc.