Heart Failure -> Cardiac Resynchronization Therapy: -> Lead and delivery systems D-AB29 - LVADs, Barostim and Pacing Issues in HF management (ID 3) Abstract Plus

D-AB29-06 - Leadless Left Ventricular Endocardial Pacing Results In Reverse Left Ventricular Remodelling And Improved Symptoms In Patients Who Are Non-responders To Conventional Epicardial Cardiac Resynchronization Therapy (ID 1473)


Background: The management of CRT non-responders remains limited. Studies have shown that endocardial LV pacing is superior to epicardial LV pacing since it allows faster electrical activation, more physiological and provides a greater selection of pacing sites enabling the selection of the optimal site without myocardial scar. The WiSE-CRT system provides endocardial LV pacing and may be particularly useful in CRT non-responders to improve patient outcomes.
Objective: Determine if the WiSE-CRT system improved patient outcomes in CRT non-responders.
Methods: All CRT non-responders who successfully had the WiSE-CRT system implanted were analysed. Patients were considered CRT responders if they had evidence of left ventricular remodelling at 6 months or had an improvement in their clinical composite score (CCS); alive, no heart failure hospitalisations, improvement in NYHA functional class or improvement in patient global assessment.
Results: Overall 22 patients were analysed; 20 patients underwent successful implantation of the WiSE-CRT system and 2 patients withdrew from the study due to failure of electrode capture. Baseline demographics include: 67.6 ± 7.3 years, 90.9% were male, 45.5% had an ischaemic cardiomyopathy, 50% had atrial fibrillation, QRS duration 169.8 ± 29.9ms and left ventricular ejection fraction [LVEF] 26.4 ± 8.0%. There were no acute complications but during the follow-up period, 1 patient developed a pocket haematoma and 1 patient developed a pocket infection at 3 months and withdrew from the study. Additionally, 18 patients proceeded to the 6 month follow-up whilst 1 patient was lost to follow-up. Overall, 55.6% of patients had an improvement in their CCS, 40.0% had an improvement in left ventricular end-systolic volume [LVESV] of ≥15% and 66.7% had an absolute increase in LVEF of ≥5% or improvement in LVESV of ≥15%.
Conclusion: The management of CRT non-responders remains difficult with limited treatment options. Our analysis has shown that in this high-risk patient group, the WiSE-CRT system results in a considerable improvement in the clinical composite score and leads to reverse left ventricular remodelling. These encouraging results suggest an important role for the WiSE-CRT system in the management of CRT non-responders.