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MultiPoint-Pacing – mehr CRT oder Batterieverschwendung?

Multipoint pacing—more CRT or a waste of battery power?

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Zusammenfassung

Die kardiale Resynchronisationstherapie (CRT) senkt Morbidität und Mortalität bei Patienten mit Herzinsuffizienz und hochgradig reduzierter linksventrikulärer Funktion sowie verbreitertem QRS-Komplex ≥130 ms unter bereits optimaler medikamentöser Therapie. Allerdings sprechen weiterhin ca. 30 % der Patienten trotz korrekter Indikation nicht auf die CRT an. Die Ursachen hierfür sind vielschichtig und können nur teilweise in der Nachsorge behoben werden. Nach Einführung quadripolarer Elektroden besteht mittels der MultiPoint-Pacing-Technologie (MPP) die Möglichkeit, an zwei verschiedenen Polen entlang der linksventrikulären Elektrode zu stimulieren. Gerade bei vernarbtem Ventrikelmyokard soll MPP zu einer gleichmäßigeren und schnelleren ventrikulären Depolarisation führen. In ersten klinischen Studien konnten die Sicherheit dieser Technologie und der klinischen Nutzen gezeigt werden. Gerade für Patienten, die von der konventionellen CRT nicht profitieren, stellt MPP eine Option dar, das Ansprechen zu verbessern. Gleichzeitig muss man den durch MPP erhöhten Stromverbrauch und die damit verbundene verkürzte Batterielaufzeit des Devices bedenken.

Diese Übersichtsarbeit bietet einen Überblick über die aktuelle Datenlage zur MPP-Technologie und stellt dem möglichen klinischen Nutzen die potenziellen Nachteile gegenüber.

Abstract

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with broad QRS complex ≥130 ms and heart failure with reduced ejection fraction despite optimal guideline-directed medical therapy. However, approximately 30% of the patients implanted with a CRT system do not show clinical benefit. Reasons for nonresponse are complex and some aspects can be addressed during follow-up. Based on quadripolar lead technology, multipoint pacing (MPP) allows left ventricular stimulation at two different sites along the lead. In particular, in scarred and fibrotic ventricular myocardium stimulation at two different sites may overcome conduction barriers and lead to homogeneous ventricular depolarization. Especially for patients that do not respond to conventional CRT, activation of MPP may present an option to increase clinical response. On the other hand, MPP may significantly decrease battery longevity.

This review offers an overview of the current knowledge and data on MPP balancing the potential clinical benefit and the possible disadvantages of this therapy.

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  1. Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Müller-Leisse, C. Zormpas, T. König, D. Duncker &  C. Veltmann

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J. Müller-Leisse: Boston Scientific, Medtronic, C. Zormpas: Biotronik, Medtronic, T. König : Boston Scientific, Biotronik, Medtronic, Abbott, D. Duncker : Boston Scientific, Biotronik, Medtronic, Abbott; Livanova/MicroPort, C. Veltmann Boston Scientific, Biotronik, Medtronic, Abbott.

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Müller-Leisse, J., Zormpas, C., König, T. et al. MultiPoint-Pacing – mehr CRT oder Batterieverschwendung?. Herz 43, 596–604 (2018). https://doi.org/10.1007/s00059-018-4751-x

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