Multipoint pacing for cardiac resynchronisation therapy in patients with heart failure: A systematic review and meta-analysis.
J Cardiovasc Electrophysiol
; 32(9): 2577-2589, 2021 09.
Article
in En
| MEDLINE
| ID: mdl-34379350
ABSTRACT
INTRODUCTION:
Multipoint pacing (MPP) has been proposed as an effective way to improve cardiac resynchronisation therapy (CRT) response. We performed a systematic review and meta-analysis evaluating the efficacy of CRT delivered via MPP compared to conventional CRT.METHODS:
A literature search was performed from inception to January 2021 for studies in Medline, Embase and Cochrane databases, comparing MPP to conventional CRT with a minimum of 6 months follow-up. Randomised and nonrandomised studies were assessed for relevant efficacy data including echocardiographic (left ventricular end systolic volume [LVESV] and ejection fraction) or functional changes (New York Heart Association [NYHA] class/Clinical Composite Score). Subgroup analyses were performed by study design and programming type.RESULTS:
A total of 7 studies with a total of 1390 patients were included in the final analysis. Overall, MPP demonstrated greater echocardiographic improvement than conventional CRT in nonrandomised studies (odds ratio [OR] 5.33, 95% confidence interval [CI] [3.05-9.33], p < .001), however, was not significant in randomised studies (OR 1.86, 95% CI [0.91-3.79], p = .086). There was no significant difference in LVESV reduction >15% (OR 1.96, 95% CI [0.69-5.55], p = .20) or improvement by ≥1 NYHA class (OR 2.49, 95% CI [0.74-8.42], p = .141) when comparing MPP to conventional CRT. In a sub analysis, MPP programmed by widest anatomical separation (MPP-AS) signalled greater efficacy, however, only 120 patients were included in this analysis.CONCLUSION:
Overall MPP was more efficacious in nonrandomised studies, and not superior when assessed in randomised studies. There was considerable heterogeneity in study design making overall interpretation of results challenging. Widespread MPP programming in all CRT patients is currently not justified. Further large, randomised studies with patient-specific programming may clarify its effectiveness.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiac Resynchronization Therapy
/
Heart Failure
Type of study:
Clinical_trials
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
J Cardiovasc Electrophysiol
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
/
FISIOLOGIA
Year:
2021
Type:
Article
Affiliation country:
United kingdom