Author + information
- Received February 16, 2017
- Revision received June 23, 2017
- Accepted June 26, 2017
- Published online December 18, 2017.
- Imran Niazi, MDa,∗ (, )
- James Baker II, MDb,
- Raffaele Corbisiero, MDc,
- Charles Love, MDd,
- David Martin, MDe,
- Robert Sheppard, MDf,
- Seth J. Worley, MDg,
- Niraj Varma, MDh,
- Kwangdeok Lee, PhDi,
- Gery Tomassoni, MDj,
- on behalf of the MPP Investigators
- aAurora Cardiovascular Services, Aurora Sinai/Aurora St Luke’s Medical Centers, Milwaukee, Wisconsin
- bSaint Thomas Research Institute, Nashville, Tennessee
- cDeborah Heart and Lung, Browns Mills, New Jersey
- dNYU Langone Medical Center, New York, New York
- eLahey Hospital and Medical Center - Cardiology, Burlington, Massachusetts
- fThe Heart Institute, St. Petersburg, Florida
- gLancaster Heart Foundation, Lancaster, Pennsylvania
- hCleveland Clinic, Cleveland, Ohio
- iAbbott, Plano, Texas
- jLexington Cardiology at Central Baptist, Lexington, Kentucky
- ↵∗Address for correspondence:
Dr. Imran Niazi, Aurora Cardiovascular Services, 2801 West Kinnickinnic River Parkway, #840, Milwaukee, Wisconsin 53215.
Objectives The MultiPoint Pacing (MPP) trial assessed the safety and efficacy of pacing 2 left ventricular sites with a quadripolar lead in patients with heart failure indicated for a CRT-D device.
Background Cardiac resynchronization therapy nonresponse is a complex problem where stimulation of multiple left ventricular sites may be a solution.
Methods Enrolled patients were indicated for a CRT-D system. Bi-ventricular (Bi-V) pacing was activated at implant. Three months later, clinical response was assessed and the patient was randomized (1:1) to receive Bi-V pacing or MPP. Patients were followed for 6 months post-randomization and clinical response was again assessed.
Results The CRT-D system was successfully implanted in 455 of 469 attempted implants (97%). A total of 381 patients were randomized to Bi-V or MPP at 3 months. The primary safety endpoint was met with freedom from system-related complications of 93.2%. The primary efficacy endpoint of the noninferiority comparison of nonresponder rates between the 2 arms was met. Patients randomized to MPP arm and programmed to pace from anatomically distant poles (MPP-AS) responded to therapy at significantly higher rates than MultiPoint pacing–other programmed settings (MPP-Other). Within this group, 87% were responders at 9 months, 100% designated as nonresponders at 3 months converted to responders at 9 months, and 54% experienced an incremental response compared to MPP-Other. Also within MPP-AS, 92% of patients with de novo CRT-D implant were classified as responders compared with patients with MPP-Other.
Conclusions MPP is safe and effective for treating heart failure. The study met the pre-specified hypothesis that response to MPP is noninferior to Bi-V pacing with a quadripolar left ventricular lead. (MultiPoint Pacing IDE Study [MPP IDE]; NCT01786993)
- bi-ventricular pacing
- cardiac resynchronization
- heart failure
- multipoint pacing
- randomized controlled trial
This trial is sponsored by Abbott. Dr. Niazi is a consultant for Medtronic Inc., Abbott, and Osprey Medical Inc.; is on the Speakers Bureau of Pfizer and Bristol-Myers Squibb; has equity interest in Medtronic Inc.; and receives research grant support from Medtronic Inc. Dr. Baker is on the Medical Device Advisory Board for Abbott. Dr. Corbisiero is a consultant for Boston Scientific and Abbott. Dr. Love is a consultant for Medtronic, Abbott, Spectranetics, and Convatec. Dr. Martin is a consultant for Biotronik and Abbott. Dr. Sheppard is a consultant for Medtronic and Abbott. Dr. Worley receives royalties from Pressure Products and Merit Medical; and receives teaching honoraria from Medtronic and Abbott. Dr. Varma is on the advisory board and is a consultant for Abbott. Dr. Lee is an employee at Abbott. Dr. Tomassoni is an advisor, speaker, and on the Medical Device Board for Abbott, Biosense Webster, Medtronic, Boston Scientific, Biotronik, Siemens, STXS, Topera, Atricure, CPI, Johnson & Johnson, and Pfizer.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 16, 2017.
- Revision received June 23, 2017.
- Accepted June 26, 2017.
- 2017 American College of Cardiology Foundation
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