MULTIPOINT LEFT VENTRICULAR PACING IN A SINGLE CORONARY
SINUS BRANCH IMPROVES 3-MONTH RESPONSE TO CARDIAC
RESYNCHRONIZATION THERAPY IN BOTH ISCHEMIC AND
NON-ISCHEMIC PATIENTS
Carlo Pappone 1 , Zarko Ćalović 1 , Amarild Cuko 1 , Luke C. McSpadden 2 , Kyungmoo Ryu 2 , Enrico
Romano3, Mario Baldi1, Alessia Pappone1, Massimo Saviano1, Luigi Giannelli1, Cristiano Ciaccio1,
Andrea Petretta 1 , Mario Moscatiello 1 , Angelica Fundaliotis 4 , Raffaele Vitale 1 , Bogdan Ionescu 1 ,
Gabriele Vicedomini1, and Vincenzo Santinelli1
1
Department of Arrhythmology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy; 2St.
Jude Medical, Sylmar, California, USA; 3 St. Jude Medical, Milan, Italy; 4 Clinical Cardiology,
Università del Piemonte A. Avogadro, Novara, Italy
Introduction: Patients with cardiomyopathy of ischemic origin have poorer response to traditional
cardiac resynchronization therapy (CRT) than patients whose cardiomyopathy is of non-ischemic origin.
We investigated whether multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], St. Jude
Medical) can improve CRT response in ischemic as well as non-ischemic patients. Methods:
Consecutive patients receiving a CRT implant (Unify Quadra MP™ or Quadra Assura MP™ CRT-D
and Quartet™ LV lead, St. Jude Medical) were randomized to receive pressure-volume loop optimized
biventricular pacing with either conventional CRT (CONV) or MPP. A clinical evaluation and
echocardiography were performed prior to implant (BASELINE) and 3 months post-implant and
analyzed by a blinded observer. Results: Forty-three patients (79% male, NYHA Class III, end-systolic
volume [ESV] 181±78 mL, ejection fraction [EF] 27±6%, QRS 152±17 ms) were enrolled and
randomized to either CONV (N=22) or MPP (N=21). Patient characteristics at BASELINE were not
significantly different between two groups. After 3 months, non-ischemic patients with MPP
experienced significantly greater ESV reduction (Fig A, p=0.01), EF increase (Fig B, p=0.002), and
NYHA class reduction (Fig C, p=0.03) relative to BASELINE compared to those with CONV. Ischemic
patients received significant EF increase with MPP over CONV (Fig B, p<0.001), while ESV reduction
(Fig A, p=0.06) and NYHA class reduction (Fig C, p=0.17) favored the MPP group but were not
statistically significant. When considering 3-month echocardiographic response (ESV >15% reduction),
response rate was greater with MPP than with CONV for non-ischemic (7/10 [70%] vs. 7/13 [54%]) and
ischemic (9/11 [82%] vs. 4/9 [44%]) patients. Conclusion: MPP improved 3-month CRT response
relative to CONV in both ischemic and non-ischemic patients.