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iBox-CRT: Optimizing CRT implant without compromising procedure duration

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), IS Goncalves (Lisbon,PT), A Nunes-Ferreira (Lisbon,PT), R Santos (Lisbon,PT), J Agostinho (Lisbon,PT), J Rigueira (Lisbon,PT), T Rodrigues (Lisbon,PT), N Cunha (Lisbon,PT), P Antonio (Lisbon,PT), S Goncalves (Lisbon,PT), L Santos (Lisbon,PT), A Bernardes (Lisbon,PT), FJ Pinto (Lisbon,PT), P Marques (Lisbon,PT), J Sousa (Lisbon,PT)

Authors:
I Aguiar Ricardo1 , IS Goncalves1 , A Nunes-Ferreira1 , R Santos1 , J Agostinho1 , J Rigueira1 , T Rodrigues1 , N Cunha1 , P Antonio1 , S Goncalves1 , L Santos1 , A Bernardes1 , FJ Pinto1 , P Marques1 , J Sousa1 , 1Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology - Lisbon - Portugal ,

Citation:

Introduction: Cardiac resynchronization therapy (CRT) involves electrical stimulation of the left ventricle (LV) in patients with heart failure, severely compromised left ventricular ejection fraction and intraventricular conduction delay. The left ventricular pacing site optimization guided by the highest electrical delay increases the response rate to cardiac resynchronization therapy. Nonetheless, the development of technology  is necessary to simplify its use.

Purpose:  The aim was to automatically, and operator-independent, assess the conduction delay between the right ventricular (RV) pacing stimulus and the LV veins in order to select the optimal LV pacing site. It was further intended to compare the total procedure and fluoroscopy times in relation to an historical control group.

Methods: Prospective, single-center study that included patients undergoing CRT implant according to the current ESC Guidelines indications. All patients were submitted to a clinical, electrocardiographic and echocardiographic evaluation prior to the procedure of CRT implantation.

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 the LV leads was guided by the longest RV-LV delay.

The total procedure and fluoroscopy times were compared to a historical control group (LAND-IT - multicenter and prospective registry of 938 patients undergoing CRT implantation).

A positive response to CRT was defined as an improvement of > 10% in LVEF or a reduction of LVESV > 15%.

Results: 60 consecutive patients were included (68.3% males, mean age 67.4 ± 10.2 years) and submitted to CRT implant (37 CRT-P; 23 CRT-D).  The left ventricular dysfunction etiology was ischemic heart disease in 26.7% (n=12) and dilated cardiomyopathy in 73.3% (n=44). The mean left ventricle ejection fraction (LVEF) was 28,8 ± 6.9%, the mean end-diastolic volume (EDV) was 197 ± 69ml; end-systolic volume (ESV) 141 ± 60ml. The mean procedure time was 65.3 ± 34min and the mean fluoroscopy time 15,1 ± 16 min. There were no major complications of the procedures. Comparing to the control group, the automatic evaluation on RV-LV delays with the iBox-CRT didn’t increase the total procedure (110±31min) nor the fluoroscopy (22±18min) times. The CRT positive response rate was 85.7%.

Conclusions: The iBox-CRT use enabled the systematic measurement of the RV-LV delays, in automatic and operator-independent fashion, in order to implant the LV lead at the most delayed site. This technique may translate into a major increase in CTR response rate, not compromising the procedure duration nor increasing the radiation exposure.

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