Stylized human heart with glowing nodes representing multiple pacing points.

Multipoint Pacing: Revolutionizing Cardiac Resynchronization Therapy?

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Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"A breakthrough trial explores the potential of multipoint pacing to improve outcomes for heart failure patients non-responsive to conventional treatments."


For many individuals battling heart failure, cardiac resynchronization therapy (CRT) has emerged as a beacon of hope, improving heart function and overall quality of life. However, a significant portion of patients, up to 40%, do not respond to this conventional treatment, leaving them in search of alternative solutions. This unmet need has spurred innovation in the field, leading to the development of multipoint pacing (MPP) as a potential game-changer.

Multipoint pacing involves stimulating multiple sites in the left ventricle of the heart to achieve more coordinated contractions. Early studies have suggested that MPP could offer improved outcomes for patients who do not respond to traditional CRT. The MultiPoint Pacing (MPP) IDE trial and the MORE-CRT MPP PHASE I study indicated enhanced responses in subjects treated with MPP, particularly when programmed with specific parameters such as wide left ventricular electrode anatomical separation and short timing delays.

To further investigate the promise of MPP, the MORE-CRT MPP PHASE II trial was initiated. This prospective, randomized, multicenter study aims to rigorously assess the safety and efficacy of MPP in patients who have not responded to conventional CRT. By exploring this advanced pacing technique, researchers hope to provide a new avenue for improving cardiac function and enhancing the lives of individuals with heart failure.

What is the MORE-CRT MPP PHASE II Trial?

Stylized human heart with glowing nodes representing multiple pacing points.

The MORE-CRT MPP PHASE II trial is designed to evaluate the impact of multipoint pacing (MPP) in patients who are non-responsive to traditional biventricular pacing (BiV). This prospective, randomized, multicenter trial seeks to determine if MPP, programmed to specific mandated settings, can improve cardiac function and overall outcomes in these challenging cases. Approximately 5,000 subjects with standard CRT indications will be enrolled and implanted with a quadripolar CRT system capable of delivering MPP. Initially, all participants will receive BiV pacing, with MPP activated only in those who do not respond after six months.

The trial employs a rigorous methodology to ensure the reliability and validity of its findings. Key elements of the study design include:

  • Patient Selection: Enrolling approximately 5,000 subjects across 250 centers worldwide, adhering to strict inclusion and exclusion criteria based on ESC and ACCF/AHA/HRS guidelines.
  • Implant Procedure: Utilizing approved Abbott CRT-D or CRT-P devices with MPP capabilities, ensuring clinicians follow standardized protocols for implantation and initial BiV pacing activation.
  • Subject Classification: Implementing a classification visit to evaluate implant success and conduct MPP vector tests, ensuring only qualified subjects with successful MPP vector tests continue in the trial.
  • Follow-up and Randomization: Monitoring subjects for six months with BiV pacing, then randomizing non-responders to either MPP or continued BiV pacing, with thorough echocardiographic evaluations to assess CRT response.
  • MPP Programming: Implementing specific MPP-AS settings, including wide vector spacing and short timing delays, to optimize the potential benefits of multipoint pacing.
By adhering to these meticulous procedures, the MORE-CRT MPP PHASE II trial aims to provide definitive evidence on the efficacy and safety of MPP, offering new insights into improving outcomes for heart failure patients who do not respond to conventional CRT.

Looking Ahead

The MORE-CRT MPP PHASE II trial holds significant promise for advancing the treatment of heart failure patients who do not respond to conventional CRT. By rigorously evaluating the safety and efficacy of multipoint pacing, this study has the potential to reshape clinical practice and improve the lives of countless individuals. As the trial progresses, the medical community eagerly awaits the results, hopeful that MPP will emerge as a valuable tool in the fight against heart failure.

About this Article -

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Everything You Need To Know

1

What is the main goal of the MORE-CRT MPP PHASE II trial?

The MORE-CRT MPP PHASE II trial aims to assess the safety and efficacy of multipoint pacing (MPP) in heart failure patients who do not respond to conventional cardiac resynchronization therapy (CRT). The trial investigates whether MPP can improve cardiac function and overall outcomes in these patients, offering a potential alternative treatment strategy for those who have not benefited from traditional biventricular pacing (BiV). The trial uses a prospective, randomized, multicenter design to rigorously evaluate the effectiveness of MPP.

2

How does multipoint pacing (MPP) differ from traditional cardiac resynchronization therapy (CRT)?

Traditional cardiac resynchronization therapy (CRT) typically involves pacing the heart from two sites, aiming to synchronize the contractions of the left and right ventricles. Multipoint pacing (MPP), on the other hand, stimulates multiple sites in the left ventricle, which could lead to more coordinated contractions. Early studies have suggested that this approach may lead to improved outcomes, particularly for patients who do not respond well to conventional CRT. The MORE-CRT MPP PHASE II trial investigates MPP's potential to provide better cardiac function and improve the quality of life.

3

What specific programming parameters are being used in the MORE-CRT MPP PHASE II trial?

The MORE-CRT MPP PHASE II trial uses specific multipoint pacing (MPP) settings to optimize potential benefits. These include wide left ventricular electrode anatomical separation and short timing delays. The study is focused on MPP-AS settings, which are crucial for maximizing the effectiveness of MPP, ensuring that the pacing is delivered in a way that best coordinates the heart's contractions. This precision in programming is vital to potentially reshape clinical practice and improve outcomes for heart failure patients.

4

Who is eligible to participate in the MORE-CRT MPP PHASE II trial, and what is the process?

The MORE-CRT MPP PHASE II trial enrolls approximately 5,000 subjects across 250 centers worldwide, adhering to ESC and ACCF/AHA/HRS guidelines. Initially, all participants receive biventricular pacing (BiV). After six months, the trial evaluates CRT response. Those who do not respond are then randomized to either MPP or continued BiV pacing. This trial design uses a thorough process that involves patient selection based on specific inclusion and exclusion criteria and uses Abbott CRT-D or CRT-P devices.

5

What are the potential implications if the MORE-CRT MPP PHASE II trial is successful?

If the MORE-CRT MPP PHASE II trial proves multipoint pacing (MPP) to be safe and effective, it could reshape the treatment landscape for heart failure patients who are non-responsive to conventional cardiac resynchronization therapy (CRT). This could lead to an improved quality of life for countless individuals. Furthermore, successful results could establish MPP as a valuable tool in the fight against heart failure, potentially leading to changes in clinical practice and the development of new guidelines for patient care, offering hope and advanced solutions for heart failure patients.

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