139-02: Comparison of the long-term efficacy of two different programming strategies for multipoint left ventricular pacing

Abstract

Purpose: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPointTM Pacing [MPP], St. Jude Medical) improves long‐term LV reverse remodeling, though questions persist about how to program LV pacing vectors and delays. We evaluated if an empirical method of programming MPP improves CRT response similar to pressure‐volume loop (PVL) optimization. Methods: Patients undergoing CRT implant (Quadra Assura MPTM CRT‐D and QuartetTM LV lead, St. Jude Medical) received MPP with programmed settings optimized either by PVL measurements at implant (PVL‐OPT group) or empirically determined by maximizing the spatial separation between the two cathodes and minimizing delays between the two pacing pulses (MAX‐SEP group). CRT response was prospectively defined as a reduction in end‐systolic volume (ESV) of >=15% relative to baseline at 6 months as determined by a blinded observer. Results: Patient characteristics at baseline (NYHA II‐III, ejection fraction [EF] 27 + 7%, QRS 151 + 17 ms) were not significantly different between the PVL‐OPT (n = 27) and MAX‐SEP (n = 26) groups. After 6 months, ESV reduction, EF increase, and CRT response rate (RR) were similar for PVL‐OPT vs. MAX‐SEP (ESV:‐20 + 11 vs.‐22 + 11%, p = 0.6, Fig A; EF: +10 + 4 vs. +9 + 7%, p = 0.5, Fig B; RR: 20/27 [74%] vs. 21/26 [81%], p = 0.7), while fewer patients in the PVL‐OPT group experienced NYHA class reduction >=2 (4/27 [15%] vs.15/26 [58%], p = 0.002, Fig C). Conclusion: Both evaluated methods of MPP programming resulted in similar, high levels of CRT response. Empirical MPP programming by maximum spatial separation of LV cathodes may be an effective, simple, and non‐invasive alternative to PVL optimization (Figure Presented).