Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

Cristiano Massacesi; Laura Ceriello; Fabrizio Maturo; Annamaria Porreca; Marianna Appignani; Enrico Di Girolamo

doi:10.1016/j.hroo.2021.09.012

Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters

Heart Rhythm O2. 2021 Dec 17;2(6Part B):682-690. doi: 10.1016/j.hroo.2021.09.012. eCollection 2021 Dec.

Authors

Cristiano Massacesi¹, Laura Ceriello², Fabrizio Maturo³, Annamaria Porreca⁴, Marianna Appignani⁵, Enrico Di Girolamo⁶

Affiliations

¹ "Dipartimento Cuore" ASL 2 Abruzzo Lanciano-Vasto-Chieti, Chieti, Italy.
² Institute of Cardiology, University G. D'Annunzio, Chieti, Italy.
³ Department of Mathematics & Physics, University of Campania Luigi Vanvitelli, Caserta, Italy.
⁴ Department of Economics, University G. D'Annunzio, Chieti-Pescara, Italy.
⁵ Intensive Cardiac Care Unit, "SS. Annunziata" Hospital, Chieti, Italy.
⁶ Arrhythmology Unit, "SS. Annunziata" Hospital, Chieti, Italy.

Abstract

Background: Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) therapy, as it has reduced mortality and morbidity and has shown improvement in functional capacity. Multipoint pacing (MPP) is a way of configuring CRT with the aim to improve the percentage of patients who respond to CRT.

Objective: To demonstrate the effectiveness of the MPP compared to traditional biventricular pacing (BiV).

Methods: We performed a systematic review and meta-analysis according to PRISMA guidelines of studies in which MPP vs BiV strategy were compared.

Results: MPP use is associated with a higher rate of patients experiencing functional improvement (odds ratio: 2.51, 95% confidence interval [CI], 1.56-4.06; P = .0002) and with higher delta LV dP/dt_max (mean difference, 1.82; 95% CI, 0.24-3.39; P = .0240) with respect to BiV. MPP and BiV have no significantly different effect on left ventricular end-systolic volume (LVESV) (mean difference, 0.39; 95% CI, -11.12 to 11.89; P = .9475); moreover, there is no significant difference between the 2 treatments regarding hospitalization for HF (odds ratio, 0.70; 95% CI, 0.32 to 1.54; P = .3816) and all-cause death (odds ratio, 0.81; 95% CI, 0.40 to 1.62; P = .5460). MPP is associated with a significantly lower projected battery longevity (mean difference -8.66 months; 95% CI, -13.67 to -3.66; P = .00007) with respect to BiV.

Conclusion: MPP significantly improves functional class and acute hemodynamic parameters with respect to BiV. Prognostic indices and LVESV are not significantly influenced by MPP. MPP is associated with a significant reduction in projected battery longevity.

Keywords: Biventricular pacing; Cardiac resynchronization therapy; Heart failure; Meta-analysis; Multipoint pacing; Quadripolar lead; Systematic review.