Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Clinical Trials D-AB04 - Innovations, Nuances and Critical Questions in CIED Management Therapies (ID 33) Abstract

D-AB04-01 - Computed Tomography With Dynamic Perfusion, Predicted Mechanics And Electrical Simulation Can Successfully Guide A Wireless Endocardial Pacing System (ID 1406)

Abstract

Background: The WiSE-CRT system delivers wireless endocardial CRT. The optimal location for the transmitter and electrode is unknown.
Objective: Whether integrated cardiac CT and simulation workflow can successfully guide placement of the transmitter and electrode.
Methods: Patients underwent a cardiac CT to identify areas of perfusion heterogeneity and the latest mechanical and electrical activation to predict target segments (TS) for electrode implant. Modelling predicted the best available intercostal space for transmitter implant that would provide good power coverage to the TS. The TS were merged and overlaid onto live fluoroscopy to guide the procedure. A pressure wire in the LV measured the acute haemodynamic response (AHR) with biventricular endocardial pacing in different myocardial segments. An improvement ≥10% in dP/dt(max) were considered a favourable location for pacing, the electrode was implanted within the area of greatest improvement in AHR.
Results: 9 consecutive patients were recruited; 67.1±6.8years; QRS 167.4±29.2ms; LVEF 27.1±6.4%. 4 patients had failed epicardial CRT, 2 high-risk upgrades and 3 non-responders to CRT. The transmitter was placed in the recommended location in all patients. AHR of pacing in different LV segments was tested; a significantly greater number of TS had AHR ≥10% vs. non-TS (93.3vs.30.8%; p<0.001). All segments with a perfusion defect on stress CT had AHR<10%. The electrode was deployed within the TS in all patients. This resulted in significant reduction in QRS duration (55.0±32.8ms; p<0.001),
Conclusion: We successfully used a pre-procedural work-flow to guide the optimal placement of the WiSE-CRT system.
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