Baldeep Singh Sidhu1,2, Benjamin Sieniewicz1,2, Justin Gould1,2, Mark K Elliott1,2, Vishal S Mehta1,2, Timothy R Betts3, Simon James4, Andrew J Turley4, Christian Butter5, Martin Seifert5, Lucas V A Boersma6, Sam Riahi7, Petr Neuzil8, Mauro Biffi9, Igor Diemberger9, Pasquale Vergara10, Martin Arnold11, David T Keane12, Pascal Defaye13, Jean-Claude Deharo14, Anthony Chow15, Richard Schilling15, Jonathan M Behar15, Christophe Leclercq16, Angelo Auricchio17, Steven A Niederer1, Christopher A Rinaldi1,2. 1. School of Biomedical Engineering and Imaging Sciences, King's College London, UK. 2. Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK. 3. Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 4. The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK. 5. Immanuel Heart Center Bernau & Brandenburg Medical School Theodor Fontane, Germany. 6. St. Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands/AUMC, Amsterdam, Netherlands. 7. Aalborg University Hospital, Aalborg, Denmark. 8. Na Homolce Hospital, Prague, Czech Republic. 9. IRCCS Policlinico S'Or 25 sola-Malpighi, Bologna, Italy. 10. San Raffaele Scientific Institute, Milan, Italy. 11. Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Cardiology, Erlangen, Germany. 12. St. Vincent's University Hospital, Dublin, Ireland. 13. CHU Grenoble Alpes, Grenoble, France. 14. Hopital La Timone, Marseille, France. 15. St. Bartholomew's Hospital, London, United Kingdom. 16. Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France. 17. Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland.
Abstract
AIMS: Cardiac resynchronization therapy (CRT) upgrades may be less likely to improve following intervention. Leadless left ventricular (LV) endocardial pacing has been used for patients with previously failed CRT or high-risk upgrades. We compared procedural and long-term outcomes in patients undergoing coronary sinus (CS) CRT upgrades with high-risk and previously failed CRT upgrades undergoing LV endocardial upgrades. METHOD AND RESULTS: Prospective consecutive CS upgrades between 2015 and 2019 were compared with those undergoing WiSE-CRT implantation. Cardiac resynchronization therapy response at 6 months was defined as improvement in clinical composite score (CCS) and a reduction in LV end-systolic volume (LVESV) ≥15%. A total of 225 patients were analysed; 121 CS and 104 endocardial upgrades. Patients receiving WiSE-CRT tended to have more comorbidities and were more likely to have previous cardiac surgery (30.9% vs. 16.5%; P = 0.012), hypertension (59.2% vs. 34.7%; P < 0.001), chronic obstructive airways disease (19.4% vs. 9.9%; P = 0.046), and chronic kidney disease (46.4% vs. 21.5%; P < 0.01) but similar LV ejection fraction (30.0 ± 8.3% vs. 29.5 ± 8.6%; P = 0.678). WiSE-CRT upgrades were successful in 97.1% with procedure-related mortality in 1.9%. Coronary sinus upgrades were successful in 97.5% of cases with a 2.5% rate of CS dissection and 5.6% lead malfunction/displacement. At 6 months, 91 WiSE-CRT upgrades and 107 CS upgrades had similar improvements in CCS (76.3% vs. 68.5%; P = 0.210) and reduction in LVESV ≥15% (54.2% vs. 56.3%; P = 0.835). CONCLUSION: Despite prior failed upgrades and high-risk patients with more comorbidities, WiSE-CRT upgrades had high rates of procedural success and similar improvements in CCS and LV remodelling with CS upgrades.
AIMS: Cardiac resynchronization therapy (CRT) upgrades may be less likely to improve following intervention. Leadless left ventricular (LV) endocardial pacing has been used for patients with previously failed CRT or high-risk upgrades. We compared procedural and long-term outcomes in patients undergoing coronary sinus (CS) CRT upgrades with high-risk and previously failed CRT upgrades undergoing LV endocardial upgrades. METHOD AND RESULTS: Prospective consecutive CS upgrades between 2015 and 2019 were compared with those undergoing WiSE-CRT implantation. Cardiac resynchronization therapy response at 6 months was defined as improvement in clinical composite score (CCS) and a reduction in LV end-systolic volume (LVESV) ≥15%. A total of 225 patients were analysed; 121 CS and 104 endocardial upgrades. Patients receiving WiSE-CRT tended to have more comorbidities and were more likely to have previous cardiac surgery (30.9% vs. 16.5%; P = 0.012), hypertension (59.2% vs. 34.7%; P < 0.001), chronic obstructive airways disease (19.4% vs. 9.9%; P = 0.046), and chronic kidney disease (46.4% vs. 21.5%; P < 0.01) but similar LV ejection fraction (30.0 ± 8.3% vs. 29.5 ± 8.6%; P = 0.678). WiSE-CRT upgrades were successful in 97.1% with procedure-related mortality in 1.9%. Coronary sinus upgrades were successful in 97.5% of cases with a 2.5% rate of CS dissection and 5.6% lead malfunction/displacement. At 6 months, 91 WiSE-CRT upgrades and 107 CS upgrades had similar improvements in CCS (76.3% vs. 68.5%; P = 0.210) and reduction in LVESV ≥15% (54.2% vs. 56.3%; P = 0.835). CONCLUSION: Despite prior failed upgrades and high-risk patients with more comorbidities, WiSE-CRT upgrades had high rates of procedural success and similar improvements in CCS and LV remodelling with CS upgrades.