The WiSE-CRT System Leads to Left Ventricular Remodeling and Improved Symptoms in Patients Who are Non-Responders to Epicardial CRT

Abstract

Background The management of heart failure (HF) patients who are CRT non-responders (symptomatic and have no evidence of reverse LV remodelling following epicardial CRT) remains limited. Endocardial LV pacing is potentially superior to epicardial LV pacing as it allows faster electrical activation, more physiological and provides a greater selection of pacing sites enabling operators to avoid myocardial scar. The WiSE-CRT system was developed to provide endocardial LV pacing and may be particularly useful in CRT non-responders. Objectives To determine whether WiSE-CRT would improve patient outcomes in CRT non-responders. Method CRT non-responders who successfully had the WiSE-CRT system implanted were analysed. Patients were followed up for 6 months. Results 17 patients were analysed, baseline demographics: 68.2±7.9 years, 94.1% male, 41.1% ischaemic, NYHA 2.8±0.4, QRS 169.1±23.8ms and LVEF 25.6±8.0%. There were no acute complications and 1 patient developed a pocket haematoma during follow-up. 58.8% of patients had an improvement in their clinical composite score (alive, no HF hospitalisations, improvement in NYHA or patient global assessment), 53.3% had an improvement in LVESV of≥15% and 64.7% 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.