176-65: Long-term reverse remodeling of cardiac resynchronization therapy with MultiPoint Pacing using noninvasive hemodynamics-guided programming

Abstract

Introduction: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPointTM Pacing [MPP], St. Jude Medical) improves acute hemodynamics and chronic outcomes compared to conventional biventricular pacing (BiV), although questions persist on MPP programming. In this multi‐center pilot study, we evaluated the feasibility of using noninvasive systolic blood pressure (SBP) to guide MPP programming, and assessed the chronic, 6‐month response. Methods: Patients ( pts) implanted with a CRT‐D device (Quadra Assura MPTM and QuartetTM LV lead, St Jude Medical) underwent noninvasive hemodynamic assessment using finger arterial pressure measurements (Finometer MIDI, Finapres Medical Systems) prior to discharge. The pacing protocol included atrial pacing only, 4 simultaneous BiV configurations with LV pacing at each of the 4 LV electrodes, and 8 MPP configurations. Each pacing configuration was repeated 4 times, alternating with a BiV reference, to calculate the SBP difference relative to reference (DSBP). Each pt was programmed to the CRT configuration with the greatest DSBP. Pts were followed for 6 months, with echocardiographic measurements analyzed by a core lab. CRT response was defined as .15% decrease in LV end‐systolic volume (DESV) at 6 months post‐implant. Results: Forty‐two pts (71% male, EF 30.3 + 7.5%, QRS duration 161 + 19 ms, 26% ischemic) were enrolled in 4 European centers. Relative to atrial pacing only, the best BiV and best MPP configurations produced significant SBP elevations of 3.1 + 4.2 (p , 0.01) and 4.1 + 4.1 mmHg (p , 0.01), respectively (MPP vs BiV, p , 0.01). Greater SBP elevations were associated with the best MPP compared to the best BiV configurations in 29/37 (78%) of pts completing the pacing protocol. Of MPP‐programmed pts completing the 6 month followup, 23/27 (85%) were classified as CRT responders (DESV = 31 + 20%). Conclusion: Acute noninvasive hemodynamics after CRT implant commonly favored MPP over BiV programming. MPP programming guided by noninvasive hemodynamics, specifically systolic blood pressure, resulted in positive LV structural remodeling.