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Long-term Reverse Remodeling and Clinical Improvement by MultiPoint Pacing in a Randomized, International, Middle Eastern Heart Failure Study
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  • AbdulMohsen AlMusaad,
  • Raed Sweidan,
  • Haitham Alanazi,
  • Fayez Bokhari,
  • Yahya S Alhebaishi,
  • Ahmed Al Fagih,
  • Bandar Al Ghamdi,
  • Naeem Alshoaibi,
  • Najib Alrawahi,
  • Ahmad Hersi,
  • Abdurahman Jamiel,
  • Amjad Al-Mandalawi ,
  • Mohammed Hashim ,
  • Mohammad Amin,
  • Mohamed ElMaghawry,
  • Antonio Sorgente,
  • Maria Loricchio,
  • Ghaliah Al Mohanny,
  • Ismail Al Abri,
  • Edmon Benjamin Khammo ,
  • Nazar Sudan ,
  • Alexandre Chami,
  • Nima Badie,
  • Mohamed Sayed
AbdulMohsen AlMusaad
King Abdulaziz Medical City
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Raed Sweidan
King Fahd Armed Forces Hospital
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Haitham Alanazi
King Abdulaziz Medical City
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Fayez Bokhari
King Fahd Armed Forces Hospital
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Yahya S Alhebaishi
Prince Sultan Cardiac Center
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Ahmed Al Fagih
Prince Sultan Cardiac Center
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Bandar Al Ghamdi
King Faisal Specialist Hospital and Research Centre
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Naeem Alshoaibi
King Abdulaziz University Hospital
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Najib Alrawahi
National Heart Center at the Royal Hospital
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Ahmad Hersi
King Khalid University Hospital
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Abdurahman Jamiel
King Abdulaziz Medical City
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Amjad Al-Mandalawi
Ibn Al-Bitar Specialized Center for Cardiac Surgery
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Mohammed Hashim
Nassiryia Heart Center
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Mohammad Amin
Bahrain Defence Force Royal Medical Services
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Mohamed ElMaghawry
Department of Cardiology
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Antonio Sorgente
Cleveland Clinic Abu Dhabi
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Maria Loricchio
Al-Amiri Hospital
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Ghaliah Al Mohanny
National Heart Center at the Royal Hospital
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Ismail Al Abri
National Herat Center at the Royal Hospital
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Edmon Benjamin Khammo
Ibn Al-Bitar Specialized Center for Cardiac Surgery
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Nazar Sudan
Nassiriya Heart Center
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Alexandre Chami
Abbott
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Nima Badie
Abbott
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Mohamed Sayed
Department of Cardiology
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Abstract

Introduction: Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing, MPP) has been shown to improve CRT response, although MPP response using automated pacing vector programming has not been demonstrated in the Middle East. Objective: Compare the impact of MPP to conventional biventricular pacing (BiV) using echocardiographic and clinical changes at 6 months post-implant. Methods: This prospective, randomized study was conducted at 13 Middle Eastern centers. After de novo CRT-D implant (Abbott Unify Quadra MP™ or Quadra Assura MP™) with quadripolar LV lead (Abbott Quartet™), patients were randomized to either BiV or MPP therapy. In BiV patients, the LV pacing vector was selected per standard practice; in MPP patients, the two LV pacing vectors were selected automatically using VectSelect. CRT response was defined at 6 months post-implant by a reduction in LV end-systolic volume (ESV) ≥15%. Results: One-hundred and forty-two patients (61 years old, 68% male, NYHA class II/III/IV 19%/75%/6%, 33% ischemic, 57% hypertension, 52% diabetes, 158 ms QRS, 25.8% ejection fraction [EF]) were randomized to either BiV (N=69) or MPP (N=73). After 6 months, MPP vs. BiV patients experienced greater ESV reduction (25.0% vs. 15.3%, P=0.08), greater EF elevation (11.9% vs. 8.6%, P=0.36), significantly greater ESV response rate (68.5% vs. 50.7%, P=0.04), and significantly greater NYHA class improvement rate (80.8% vs. 60.3%, P=0.01). Conclusions: With MPP and automatic LV vector selection, more CRT patients in the Middle East experienced reverse remodeling and clinical improvement relative to conventional BiV pacing.