Effectiveness of multipoint cardiac resynchronizing therapy in heart failure: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Background

Cardiac resynchronization therapy is an important validated technique for patients with dyssynchrony and heart failure. However, the response rate to conventional resynchronization is approximately 50%; therefore, new techniques and schedules have emerged. This study aimed to evaluate the different clinical and echocardiographic variables of conventional versus multipoint cardiac resynchronization therapy.

Research design and method

A systematic review was conducted of randomized clinical trials in the PubMed, Cochrane, and Embase databases on cardiac resynchronization intervention with multipoint stimulation clinical and echocardiographic outcomes evaluated before and 3 months after the intervention.

Results

Three studies (N = 139) were ultimately selected, and 100% of patients had a New York Heart Association functional class of II–IV, QRS > 120 ms, and a left ventricular ejection fraction < 35%. Significantly greater improvement was observed in the functional class of patients who underwent multipoint versus conventional therapy. The final systolic volume and ejection fraction improved in the multipoint group, but the difference was not statistically significant.

Conclusions

The literature lacks sufficient randomized controlled studies to enable conclusions regarding cardiac resynchronization therapy responses using different strategies. Moreover, the improvement in functional class in the multipoint pacing group involved few patients and had slight statistical relevance.

KEYWORDS:

• Biventricular pacing
• heart failure
• metanalysis
• multipoint pacing
• systematic review

Protocol and Registration

This review was registered on the Prospero platform and can be accessed publicly by the access code PROSPERO 2018 CRD42018093835.

Financing

This review was financed exclusively by the researchers’ own resources.

Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Author contributions

A.B.: Drafting of article, funding, and data collection.

P.G.M.P: Study concept/design and data collection/analysis/interpretation

A.S.M.J.: Critical revision of article, approval of article, data collection and statistics.

L.C.G.: Analysis/interpretation and statistics

V.A.B: Drafting of article, funding, and data collection

J.F.F: Analysis/interpretation and statistics

T.A.L: Critical revision of article, approval of article

A.M.T.C.S: Analysis/interpretation and statistics

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.