Introduction

Cardiac resynchronization therapy (CRT) provides significant long-term benefits to patients with moderate to severe heart failure (HF), prolonged QRS duration, and reduced ejection fraction (EF).1–3 However, up to 40% of patients fail to clinically respond to conventional CRT.4,5 Multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP], Abbott, Sylmar, CA), stimulating two LV sites on a quadripolar lead, is one key strategy to improve CRT response over conventional biventricular (BiV) pacing.
Head-to-head comparisons have demonstrated improvements of MPP over BiV in terms of LV pressure response6–9, LV peak radial strain10, LV electrical activation11, and long-term LV function12–15. The benefits of the additional LV pacing vector, however, come with the burden of additional programming options. In MPP clinical studies to date, selection of the two LV pacing vectors (each with up to 14 LV cathode-anode combinations) has either (1) been guided by manual, in-clinic electrical or hemodynamic measurements, or (2) left entirely to the discretion of the physician. Consequently, any clinical improvement ultimately observed cannot be directly associated with a single, consistent programming guideline that can be implemented routinely in-clinic. The current study is the first randomized comparison of MPP and BiV in the Middle East that relied solely on one automated, programmer-based tool (VectSelectTM, Abbott) which provides MPP LV pacing vector recommendations that are both patient-specific and require minimal physician input.
In this prospective, multi-center investigation, patients were implanted with CRT-D devices and randomized to receive either BiV pacing or MPP. Patient response to CRT was quantified after 6 months by reductions in LV end-systolic volume (ESV) and elevations in LV ejection fraction (EF), both indicative of a reversal of the LV dilation and dysfunction associated with heart failure (i.e., LV reverse remodeling).