Leadless left ventricular endocardial pacing for CRT upgrades in previously failed and high-risk patients in comparison with coronary sinus CRT upgrades

Sidhu BS, Sieniewicz B, Gould J, Elliott MK, Mehta VS, Betts TR, James S, Turley AJ, Butter C, Seifert M, Boersma LVA, Riahi S, Neuzil P, Biffi M, Diemberger I, Vergara P, Keane DT, Defaye P, Deharo JC, Chow A, Schilling R, Behar JM, Leclercq C, Auricchio A, Niederer SA, Rinaldi CA, Arnold M (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Europace Oxford University Press

Book Volume: 23

Pages Range: 1577-1585

Journal Issue: 10

DOI: 10.1093/europace/euab156

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.

Authors with CRIS profile

Martin Arnold Department of Medicine 2 – Cardiology and Angiology

Involved external institutions

King’s College London GB United Kingdom (GB) Oxford University Hospitals NHS Foundation Trust GB United Kingdom (GB) South Tees Hospitals NHS Foundation Trust GB United Kingdom (GB) Immanuel Albertinen Diakonie DE Germany (DE) St. Antonius Ziekenhuis NL Netherlands (NL) Aalborg University DK Denmark (DK) Na Homolce Hospital CZ Czech Republic (CZ) Ospedaliero Universitaria di Bologna Policlinico S.Orsola-Malpighi IT Italy (IT) San Rafaele Scientific Institute IT Italy (IT) St Vincent's University Hospital IE Ireland (IE) Centre hospitalier universitaire de Grenoble FR France (FR) Hôpital de la Timone FR France (FR) Barts Health NHS Trust GB United Kingdom (GB) Université de Rennes 1 / University of Rennes 1 FR France (FR) Cardiocentro Ticino CH Switzerland (CH)

How to cite

APA:

Sidhu, B.S., Sieniewicz, B., Gould, J., Elliott, M.K., Mehta, V.S., Betts, T.R.,... Arnold, M. (2021). Leadless left ventricular endocardial pacing for CRT upgrades in previously failed and high-risk patients in comparison with coronary sinus CRT upgrades. Europace, 23(10), 1577-1585. https://doi.org/10.1093/europace/euab156

MLA:

Sidhu, Baldeep Singh, et al. "Leadless left ventricular endocardial pacing for CRT upgrades in previously failed and high-risk patients in comparison with coronary sinus CRT upgrades." Europace 23.10 (2021): 1577-1585.

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