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Multipoint pacing in cardiac resynchronization therapy - how to improve remodeling criteria and its impact in quality of life
Session:
Sessão de Comunicações Orais - Dispositivos Médicos
Speaker:
Afonso Nunes Ferreira
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Nunes Ferreira; Pedro Silvério António; Inês Aguiar Ricardo; Tiago Graça Rodrigues; Joana Rigueira; Nelson P. Cunha; Rafael Santos; Pedro Morais; Mafalda Carrington; Igor Santos; Ana Bernardes; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p>Background: 30-40% of patients who implant cardiac resynchronization therapy (CRT) are non-responders. Several studies are evaluating the conversion rate of non-responder to responder with multipoint pacing (MPP) in the. However, there is still lack of information about conversion to super-responders and the impact in quality of life of MPP.</p> <p>Purpose: To evaluate the impact of MPP in conversion to super-responders and its impact in the quality of life of patients.</p> <p>Methods:<br /> Randomized clinical trial of non-AF patients with indication for CRT and who implanted the Quartet™ quadripolar left ventricle (LV) lead. After implant, CRTs were programmed on biventricular pacing according to the latest activated area for 6 months. After a 6-month follow-up, patients were randomized in a 1:1 fashion to MPP ON or MPP OFF. MPP was programmed with the two widest spaced LV electrodes and with a LV1-LV2 to LV2-RV delay of 5ms. Patients were followed-up for 12 months with a 6-month evaluation of NTproBNP, echocardiographic remodeling criteria (LV end systolic volume (ESV) and LV ejection fraction), and quality of life (QoL) evaluated by EQ-5D, Minnesota Living with Heart Failure (MLWHF) questionnaire and 6-minute walk test (6MWT).</p> <p>Results:<br /> 76 patients were included, 62 with a completed 12-month follow-up (mean age 67.2±10.2 years, 32.3% female, 77.4% dilated cardiomyopathy). Among these patients, 24 were randomized to MPP ON, 28 to MPP OFF. Six patients died and 4 were lost to follow-up. <br /> At 6 months, the overall response rate (reduction in ESV≥15%) was 75%. At 12 months, patients randomized to MPP ON had a super-response rate (reduction in ESV≥30%) higher than patients with MPP OFF (75% vs 39.3%, p=0.01).<br /> Between 6-12 months, patients assigned to MPP ON had a higher reduction in ESV (93.4±52.3mL to 82.1±40.5mL, p=0.04) and an improvement in LVEF (38.3±9.8% to 45.1±11.1%, p<0.01) compared to patients with MPP OFF (92.2±47.3mL to 95.4±47.5mL, p=NS; 37.1±12.0% to 40.2±9.2%, p=NS). QoL of patients with MPP ON improved during follow up (EQ-5D 78.3% to 86.3%, p<0.01; MLWHF 12.1 to 6.6, p=0.03, 6MWT 316m to 239m, p=NS; NTproBNP 1608±2450pg/mL to 775±914pg/mL, p=NS) and was unchanged in MPP OFF patients (76.6% to 74.2%; MLWHF 12.7 to 12.7; 6MWT 338m to 299m, NTproBNP 1112±1442pg/mL to 1383±2118pg/mL, for all p=NS).</p> <p>Conclusion:<br /> In our population, patients with CRT programmed with MPP ON, when compared to MPP OFF, had an improvement in the super-response rate and in QoL, probably due to the decrease in ESV.</p>
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