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Article Dans Une Revue EP-Europace Année : 2023

Cardiac resynchronization therapy non-responder to responder conversion rate in the MORE-CRT MPP trial

Résumé

Aims: To assess the impact of MultiPoint™ Pacing (MPP) in cardiac resynchronization therapy (CRT) non-responders after 6 months of standard biventricular pacing (BiVP).Methods and results: The trial enrolled 5850 patients who planned to receive a CRT device. The echocardiography core laboratory assessed CRT response before implant and after 6 months of BiVP; non-response to BiVP was defined as <15% relative reduction in left ventricular end-systolic volume (LVESV). Echocardiographic non-responders were randomized in a 1:1 ratio to receive MPP (541 patients) or continued BiVP (570 patients) for an additional 6 months and evaluated the conversion rate to the echocardiographic response. The characteristics of both groups at randomization were comparable. The percentage of non-responder patients who became responders to CRT therapy was 29.4% in the MPP arm and 30.4% in the BIVP arm (P = 0.743). In patients with ≥30 mm spacing between the two left ventricular pacing sites (MPP-AS), identified during the first phase as a potential beneficial subgroup, no significant difference in the conversion rate was observed.Conclusion: Our trial shows that ∼30% of patients, who do not respond to CRT in the first 6 months, experience significant reverse remodelling in the following 6 months. This finding suggests that CRT benefit may be delayed or slowly incremental in a relevant proportion of patients and that the percentage of CRT responders may be higher than what has been described in short-/middle-term studies. MultiPoint™ Pacing does not improve CRT response in non-responders to BiVP, even with MPP-AS.Keywords: Biventricular pacing; Cardiac resynchronization; Heart failure; MPP; MultiPoint Pacing; Quadripolar left ventricular pacing; Randomized controlled study. (ClinicalTrials.gov Identifier: NCT02006069)
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hal-04266693 , version 1 (31-10-2023)

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Paternité - Pas d'utilisation commerciale

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Christophe Leclercq, Haran Burri, Peter Paul Delnoy, Christopher A Rinaldi, Johannes Sperzel, et al.. Cardiac resynchronization therapy non-responder to responder conversion rate in the MORE-CRT MPP trial. EP-Europace, 2023, 25 (10), pp.1-11. ⟨10.1093/europace/euad294⟩. ⟨hal-04266693⟩
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