Author + information
- Received December 18, 2017
- Revision received March 8, 2018
- Accepted March 8, 2018
- Published online July 16, 2018.
- Benjamin J. Sieniewicz, MBChBa,b,∗ (, )
- Jonathan M. Behar, MBBSa,b,
- Justin Gould, MBBSa,b,
- Simon Claridge, MBBSa,b,
- Bradley Porter, MBBSa,b,
- Baldeep S. Sidhu, BMa,b,
- Steve Niederer, PhDa,
- Tim R. Betts, MBChB, MDc,
- David Websterc,
- Simon James, MBChBd,
- Andrew J. Turley, MBChBd and
- Christopher A. Rinaldi, MDa,b
- aDivision of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom
- bCardiology Department, Guys and St. Thomas’ National Health Service (NHS) Foundation Trust, London, United Kingdom
- cCardiology Department, The John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- dCardiology Department, The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
- ↵∗Address for correspondence:
Dr. Benjamin J. Sieniewicz, Department of Imaging Sciences and Biomedical Engineering, 4th Floor, North Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.
Objectives This study hypothesized that guided implants, in which the optimal left ventricular endocardial (LVENDO) pacing location was identified and targeted, would improve acute markers of contractility and chronic markers of cardiac resynchronization (CRT) response.
Background Biventricular endocardial (BiVENDO) pacing may offer a potential benefit over standard CRT; however, the optimal LVENDO pacing site is highly variable. Indiscriminately delivered BiVENDO pacing is associated with a reverse remodeling response rate of between 40% and 60%.
Methods Registry of centers implanting a wireless, LVENDO pacing system (WiSE-CRT System, EBR Systems, Sunnyvale, California); John Radcliffe Hospital (Oxford, United Kingdom), Guy's and St. Thomas' Hospital (London, United Kingdom), and The James Cook University Hospital (Middlesbrough, United Kingdom). Centers used a combination of preprocedural imaging and electroanatomical mapping the identify the optimal LVENDO site.
Results A total of 26 patients across the 3 centers underwent a guided implant. Patients were predominantly male with a mean age of 68.8 ± 8.4 years, the mean LV ejection fraction was 34.2 ± 7.8%. The mean QRS duration was 163.8 ± 26.7 ms, and 30.8% of patients had an ischemic etiology. It proved technically feasible to selectively target and deploy the pacing electrode in a chosen endocardial segment in almost all cases, with a similar complication rate to that observed during indiscriminate BiVENDO. Ninety percent of patients met the definition of echocardiographic responder. Reverse remodeling was observed in 71%.
Conclusions Guided endocardial implants were associated with a higher degree of chronic LV remodeling compared with historical nonguided approaches.
Dr. Sieniewicz is supported by a British Heart Foundation Project Grant. Dr. Behar has received speakers fees from Abbott. Drs. Gould and Porter are on clinical research fellowship programs funded by Abbott. Dr. Sidhu is on a clinical research fellowship program funded by Medtronic Inc. Dr. Niederer is supported by the Wellcome Trust. Dr. Betts has received research funding from Abbott; has received speaker, consultancy, and proctor fees from Abbott and Boston Scientific; and he is supported by the Oxford Biomedical Research Centre. Dr. Rinaldi has received research funding and/or consultancy fees from Abbott, Medtronic Inc., Boston, and LivaNova; has received speaker fees and honoraria from EBR Systems; and is part of the steering group for SOLVE-CRT Study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 18, 2017.
- Revision received March 8, 2018.
- Accepted March 8, 2018.
- 2018 The Authors