Heart Failure -> Cardiac Resynchronization Therapy: -> Device Technology and Programming D-PO02 - Poster Session II (ID 47) Poster

D-PO02-067 - Does Cardiac Resynchronisation Using The WiSE-CRT Leadless Left Ventricular Pacing System Result In Greater QRS Shortening Than Conventional Cardiac Resynchronisation Devices? (ID 999)

Abstract

Background: Cardiac resynchronisation therapy (CRT) induced acute shortening of QRS duration predicts long term mortality. WiSE-CRT is a leadless endocardial pacing system. It uses ultrasound technology to transfer energy to a receiver implanted on the Left Ventricle (LV) endocardial wall. This can be implanted at any site within the LV.
Objective: To assess if LV leadless pacing at a site of latest activation results in greater acute QRS shortening than conventional CRT
Methods: WiSE-CRT implants were compared with an equal number of consecutive conventional CRT cases. Leadless LV electrodes were implanted at the site of latest activation defined by strain echocardiography.
Conventional CRT were via standard coronary sinus route. Intrinsic QRS width was measured pre/ post-implant. For pacing dependent cases the QRS width during RV pacing was measured.
Results: 24 patients underwent WiSE-CRT implant. (6 pacing dependent, 18 intrinsic conduction) were compared with 24 consecutive conventional CRT (6 pacing dependent). Cases were well matched for baseline QRS duration. Underlying pathologies for WiSE-CRT & conventional CRT were ischaemic 11 v 14, dilated cardiomyopathy 4 v 6, pacing induced LV impairment 4 v 4 respectively.
WiSE-CRT resulted in greater QRS reduction for all cases (51msec v 32, p=0.002), intrinsic conduction (51 v 29, p = 0.003) and pacing dependent (60 v 40, p= 0.15)
Conclusion: WiSE-CRT implant demonstrate a greater acute QRS shortening than conventional CRT. This should confer improved mortality.
Further investigation is needed to ascertain whether this is due to targeting a specific site of latest activation or a specific property of endocardial pacing itself
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