Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy

Baldeep S. Sidhu; Bradley Porter; Justin Gould; Benjamin Sieniewicz; Mark Elliott; Vishal Mehta; Peter P.H.M. Delnoy; Jean Claude Deharo; Christian Butter; Martin Seifert; Lucas V.A. Boersma; Sam Riahi; Simon James; Andrew J. Turley; Angelo Aurrichio; Timothy R. Betts; Steven Niederer; Prashanthan Sanders; Christopher A. Rinaldi

doi:10.1111/pace.13926

Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy

Baldeep S. Sidhu^*, Bradley Porter, Justin Gould, Benjamin Sieniewicz, Mark Elliott, Vishal Mehta, Peter P.H.M. Delnoy, Jean Claude Deharo, Christian Butter, Martin Seifert, Lucas V.A. Boersma, Sam Riahi, Simon James, Andrew J. Turley, Angelo Aurrichio, Timothy R. Betts, Steven Niederer, Prashanthan Sanders, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Background: Endocardial pacing may be beneficial in patients who fail to improve following conventional epicardial cardiac resynchronization therapy (CRT). The potential to pace anywhere inside the left ventricle thus avoiding myocardial scar and targeting the latest activating segments may be particularly important. The WiSE-CRT system (EBR systems, Sunnyvale, CA) reliably produces wireless, endocardial left ventricular (LV) pacing. The purpose of this analysis was to determine whether this system improved symptoms or led to LV remodeling in patients who were nonresponders to conventional CRT. Method: An international, multicenter registry of patients who were nonresponders to conventional CRT and underwent implantation with the WiSE-CRT system was collected. Results: Twenty-two patients were included; 20 patients underwent successful implantation with confirmation of endocardial biventricular pacing and in 2 patients, there was a failure of electrode capture. Eighteen patients proceeded to 6-month follow-up; endocardial pacing resulted in a significant reduction in QRS duration compared with intrinsic QRS duration (26.6 ± 24.4 ms; P =.002) and improvement in left ventricular ejection fraction (LVEF) (4.7 ± 7.9%; P =.021). The mean reduction in left ventricular end-diastolic volume was 8.3 ± 42.3 cm³ (P =.458) and left ventricular end-systolic volume (LVESV) was 13.1 ± 44.3 cm³ (P =.271), which were statistically nonsignificant. Overall, 55.6% of patients had improvement in their clinical composite score and 66.7% had a reduction in LVESV ≥15% and/or absolute improvement in LVEF ≥5%. Conclusion: Nonresponders to conventional CRT have few remaining treatment options. We have shown in this high-risk patient group that the WiSE-CRT system results in improvement in their clinical composite scores and leads to LV remodeling.

Original language	English
Pages (from-to)	966-973
Number of pages	8
Journal	PACE - Pacing and Clinical Electrophysiology
Volume	43
Issue number	9
DOIs	https://doi.org/10.1111/pace.13926
Publication status	Published - 1 Sept 2020

Keywords

cardiac resynchronization therapy
endocardial pacing
WiSE-CRT system

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10.1111/pace.13926

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Sidhu, B. S., Porter, B., Gould, J., Sieniewicz, B., Elliott, M., Mehta, V., Delnoy, P. P. H. M., Deharo, J. C., Butter, C., Seifert, M., Boersma, L. V. A., Riahi, S., James, S., Turley, A. J., Aurrichio, A., Betts, T. R., Niederer, S., Sanders, P., & Rinaldi, C. A. (2020). Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy. PACE - Pacing and Clinical Electrophysiology, 43(9), 966-973. https://doi.org/10.1111/pace.13926

@article{8360ed89695349109a63d6cdffa42ca2,

title = "Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy",

abstract = "Background: Endocardial pacing may be beneficial in patients who fail to improve following conventional epicardial cardiac resynchronization therapy (CRT). The potential to pace anywhere inside the left ventricle thus avoiding myocardial scar and targeting the latest activating segments may be particularly important. The WiSE-CRT system (EBR systems, Sunnyvale, CA) reliably produces wireless, endocardial left ventricular (LV) pacing. The purpose of this analysis was to determine whether this system improved symptoms or led to LV remodeling in patients who were nonresponders to conventional CRT. Method: An international, multicenter registry of patients who were nonresponders to conventional CRT and underwent implantation with the WiSE-CRT system was collected. Results: Twenty-two patients were included; 20 patients underwent successful implantation with confirmation of endocardial biventricular pacing and in 2 patients, there was a failure of electrode capture. Eighteen patients proceeded to 6-month follow-up; endocardial pacing resulted in a significant reduction in QRS duration compared with intrinsic QRS duration (26.6 ± 24.4 ms; P =.002) and improvement in left ventricular ejection fraction (LVEF) (4.7 ± 7.9%; P =.021). The mean reduction in left ventricular end-diastolic volume was 8.3 ± 42.3 cm3 (P =.458) and left ventricular end-systolic volume (LVESV) was 13.1 ± 44.3 cm3 (P =.271), which were statistically nonsignificant. Overall, 55.6% of patients had improvement in their clinical composite score and 66.7% had a reduction in LVESV ≥15% and/or absolute improvement in LVEF ≥5%. Conclusion: Nonresponders to conventional CRT have few remaining treatment options. We have shown in this high-risk patient group that the WiSE-CRT system results in improvement in their clinical composite scores and leads to LV remodeling.",

keywords = "cardiac resynchronization therapy, endocardial pacing, WiSE-CRT system",

author = "Sidhu, {Baldeep S.} and Bradley Porter and Justin Gould and Benjamin Sieniewicz and Mark Elliott and Vishal Mehta and Delnoy, {Peter P.H.M.} and Deharo, {Jean Claude} and Christian Butter and Martin Seifert and Boersma, {Lucas V.A.} and Sam Riahi and Simon James and Turley, {Andrew J.} and Angelo Aurrichio and Betts, {Timothy R.} and Steven Niederer and Prashanthan Sanders and Rinaldi, {Christopher A.}",

year = "2020",

month = sep,

day = "1",

doi = "10.1111/pace.13926",

language = "English",

volume = "43",

pages = "966--973",

journal = "PACE - Pacing and Clinical Electrophysiology",

issn = "0147-8389",

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number = "9",

}

Sidhu, BS , Porter, B , Gould, J , Sieniewicz, B , Elliott, M , Mehta, V, Delnoy, PPHM, Deharo, JC, Butter, C, Seifert, M, Boersma, LVA, Riahi, S, James, S, Turley, AJ, Aurrichio, A, Betts, TR, Niederer, S, Sanders, P & Rinaldi, CA 2020, 'Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy', PACE - Pacing and Clinical Electrophysiology, vol. 43, no. 9, pp. 966-973. https://doi.org/10.1111/pace.13926

TY - JOUR

T1 - Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy

AU - Sidhu, Baldeep S.

AU - Porter, Bradley

AU - Gould, Justin

AU - Sieniewicz, Benjamin

AU - Elliott, Mark

AU - Mehta, Vishal

AU - Delnoy, Peter P.H.M.

AU - Deharo, Jean Claude

AU - Butter, Christian

AU - Seifert, Martin

AU - Boersma, Lucas V.A.

AU - Riahi, Sam

AU - James, Simon

AU - Turley, Andrew J.

AU - Aurrichio, Angelo

AU - Betts, Timothy R.

AU - Niederer, Steven

AU - Sanders, Prashanthan

AU - Rinaldi, Christopher A.

PY - 2020/9/1

Y1 - 2020/9/1

N2 - Background: Endocardial pacing may be beneficial in patients who fail to improve following conventional epicardial cardiac resynchronization therapy (CRT). The potential to pace anywhere inside the left ventricle thus avoiding myocardial scar and targeting the latest activating segments may be particularly important. The WiSE-CRT system (EBR systems, Sunnyvale, CA) reliably produces wireless, endocardial left ventricular (LV) pacing. The purpose of this analysis was to determine whether this system improved symptoms or led to LV remodeling in patients who were nonresponders to conventional CRT. Method: An international, multicenter registry of patients who were nonresponders to conventional CRT and underwent implantation with the WiSE-CRT system was collected. Results: Twenty-two patients were included; 20 patients underwent successful implantation with confirmation of endocardial biventricular pacing and in 2 patients, there was a failure of electrode capture. Eighteen patients proceeded to 6-month follow-up; endocardial pacing resulted in a significant reduction in QRS duration compared with intrinsic QRS duration (26.6 ± 24.4 ms; P =.002) and improvement in left ventricular ejection fraction (LVEF) (4.7 ± 7.9%; P =.021). The mean reduction in left ventricular end-diastolic volume was 8.3 ± 42.3 cm3 (P =.458) and left ventricular end-systolic volume (LVESV) was 13.1 ± 44.3 cm3 (P =.271), which were statistically nonsignificant. Overall, 55.6% of patients had improvement in their clinical composite score and 66.7% had a reduction in LVESV ≥15% and/or absolute improvement in LVEF ≥5%. Conclusion: Nonresponders to conventional CRT have few remaining treatment options. We have shown in this high-risk patient group that the WiSE-CRT system results in improvement in their clinical composite scores and leads to LV remodeling.

AB - Background: Endocardial pacing may be beneficial in patients who fail to improve following conventional epicardial cardiac resynchronization therapy (CRT). The potential to pace anywhere inside the left ventricle thus avoiding myocardial scar and targeting the latest activating segments may be particularly important. The WiSE-CRT system (EBR systems, Sunnyvale, CA) reliably produces wireless, endocardial left ventricular (LV) pacing. The purpose of this analysis was to determine whether this system improved symptoms or led to LV remodeling in patients who were nonresponders to conventional CRT. Method: An international, multicenter registry of patients who were nonresponders to conventional CRT and underwent implantation with the WiSE-CRT system was collected. Results: Twenty-two patients were included; 20 patients underwent successful implantation with confirmation of endocardial biventricular pacing and in 2 patients, there was a failure of electrode capture. Eighteen patients proceeded to 6-month follow-up; endocardial pacing resulted in a significant reduction in QRS duration compared with intrinsic QRS duration (26.6 ± 24.4 ms; P =.002) and improvement in left ventricular ejection fraction (LVEF) (4.7 ± 7.9%; P =.021). The mean reduction in left ventricular end-diastolic volume was 8.3 ± 42.3 cm3 (P =.458) and left ventricular end-systolic volume (LVESV) was 13.1 ± 44.3 cm3 (P =.271), which were statistically nonsignificant. Overall, 55.6% of patients had improvement in their clinical composite score and 66.7% had a reduction in LVESV ≥15% and/or absolute improvement in LVEF ≥5%. Conclusion: Nonresponders to conventional CRT have few remaining treatment options. We have shown in this high-risk patient group that the WiSE-CRT system results in improvement in their clinical composite scores and leads to LV remodeling.

KW - cardiac resynchronization therapy

KW - endocardial pacing

KW - WiSE-CRT system

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U2 - 10.1111/pace.13926

DO - 10.1111/pace.13926

M3 - Article

C2 - 32330307

AN - SCOPUS:85084379072

SN - 0147-8389

VL - 43

SP - 966

EP - 973

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

IS - 9

ER -

Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy

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