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iBox-CRT: Can we do it better?

Session Poster session 3

Speaker Ines Aguiar Ricardo

Event : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session

Authors : I Aguiar Ricardo (Lisbon,PT), J Goncalves (Lisbon,PT), A Nunes-Ferreira (Lisbon,PT), J Agostinho (Lisbon,PT), J Rigueira (Lisbon,PT), R Santos (Lisbon,PT), N Cunha (Lisbon,PT), T Rodrigues (Lisbon,PT), S Goncalves (Lisbon,PT), L Santos (Lisbon,PT), A Magalhaes (Lisbon,PT), H Costa (Lisbon,PT), FJ Pinto (Lisbon,PT), P Marques (Lisbon,PT), J Sousa (Lisbon,PT)

Authors:
I Aguiar Ricardo1 , J Goncalves1 , A Nunes-Ferreira1 , J Agostinho1 , J Rigueira1 , R Santos1 , N Cunha1 , T Rodrigues1 , S Goncalves1 , L Santos1 , A Magalhaes1 , H Costa1 , FJ Pinto1 , P Marques1 , J Sousa1 , 1Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology - Lisbon - Portugal ,

Citation:

Introduction: Cardiac resynchronization therapy is associated with reduced mortality, morbidity and improved quality of life in patients with low ejection fraction and conduction delays. The optimization of the left ventricle (LV) pacing site guided by the electrical delay increases CRT response, however it’s necessary to develop technology that allows its universal use.

Purpose: The aim is to automatically, and operator-independent, assess the conduction delay between the right ventricular (RV) stimulus and the LV available veins in order to select the LV pacing site. It’s also intended to evaluate the impact of this selection on clinical and remodeling outcomes.

Methods: Prospective, single-center study including consecutive patients undergoing CRT implant according to the current ESC Guidelines indications. All patients were submitted to a clinical (including quality of life of EQ-5D Questionnaire), electrocardiographic and echocardiographic basal evaluation prior to the procedure of CRT implantation.  A reassessment of all parameters was performed at 6 months of follow-up, and all the echocardiographic data was analyzed by an independent core lab.

The implant of all the LV leads was guided by the longest measured delay. To evaluate conduction delays between the RV lead and the LV available veins (RV-LV delay), an external interface - intelligent Box for CRT (iBox-CRT) was used. Four measurements in at least two different tributary veins were made. The implant of all the LV lead was guided by the longest RV-LV delay. A positive CRT response was considered in case of LVESV reduction > 15% or improvement in LVEF >10%.

Results: 60 patients were included (68.3% males, 26.7% ischemic, mean age 67.4 ± 10.2 years) and submitted to CRT implant (37 CRT-P; 23 CRT-D). At basal evaluation, the mean left ventricle ejection fraction (LVEF) was 28,8 ± 6.9%, end-diastolic volume (LVEDV) was 197 ± 69ml and end-systolic volume (LVESV) 141 ± 60ml.

At 6 months follow-up, 2 patients died (3.3%) and 85.7% were considered responders. The LVESV reduced 38.2±3% in responders vs 5.7±2% in non-responders (p=0,005), LVEDV reduced 33.3±16% in responders vs 13.6±10% in non-responders (p=0.002) and the mean LVEF improvement in responders was 11% vs -1% in non-responders (p=0.02). The quality of life score significantly improved in both groups (EQ-5D at baseline 69.6±17 vs 78.5±15 at follow-up (p=0.001).

Conclusions: The iBox-CRT allowed the simple and automatic measurement of the RV-LV delays guiding LV lead implant, using this toll 85.7% response rate was achieved based on remodeling criteria.

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