Exercise Capacity and the Force Frequency Relationship in Multi-Point Versus Single-Point Pacing: A Randomized Trial

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Treatment

Background:

• Quadripolar left ventricular (LV) epicardial leads offer multipoint pacing (MPP) for cardiac resynchronization therapy (CRT).
• MPP may enhance CRT by stimulating the LV lateral wall from two locations simultaneously, potentially improving outcomes over conventional bipolar leads.

Purpose of the Study:

• To compare the acute and longer-term effects of MPP versus single-point pacing (SPP) on LV contractility and exercise capacity.
• To evaluate the efficacy of MPP in patients with heart failure with reduced ejection fraction undergoing CRT.

Main Methods:

• A randomized crossover study assessed acute effects of MPP vs. SPP on LV contractility via echocardiography.
• Cardiopulmonary exercise testing was performed at 6 weeks and 6 months.
• A parallel-group study randomized patients to MPP or SPP for 6 additional months.

Main Results:

• Twenty-three participants (mean age 73, 91% male, NYHA class II, LVEF 31.3%) were included.
• Acute LV contractility was significantly higher with MPP at rest (p = 0.019).
• No significant differences in contractility at higher heart rates or 6-month follow-up; no differences in exercise performance were observed.

Conclusions:

• Cardiac resynchronization therapy with MPP acutely improved LV contractility at resting heart rates.
• MPP did not demonstrate consistent short- or longer-term mechanistic or patient-oriented benefits compared to SPP.