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iBox-CRT – Optimizing CRT implant without compromising procedure duration
Session:
Posters 1 - Écran 3 - Arritmologia
Speaker:
Inês Ricardo
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Inês Aguiar Ricardo; Joana Rigueira; João Pedro Ribeiro Agostinho; Rafael Santos; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Nelson P. Cunha; Susana Gonçalves; Ana Bernardes; Pedro Nuno Carlos Marques; Fausto José Pinto; João Rodrigues De Sousa
Abstract
<p><strong>Introduction:</strong> 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 (RR) to cardiac resynchronization therapy. Nonetheless, the development of technology is necessary to simplify its use.</p> <p><strong>Purpose</strong>: 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 evaluate the impact of this tecnique on RR and to compare the total procedure and fluoroscopy times in relation to a control group.</p> <p><strong>Methods:</strong> Prospective, single-center study that included patients undergoing CRT implant according to the current ESC Guidelines indications.</p> <p>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.</p> <p>A positive response to CRT was defined as an improvement of > 10% in LVEF or a reduction of end-systolic volume (ESV) > 15%. The results were compared to a control group (GC) of pts submitted to CRT implantation in the conventional way.</p> <p><strong>Results: </strong>60 dts were included in the study group (SG) (68.3% male, mean age 67.4 ± 10.2 years, 38% ischemic disease). Baseline assessment: mean LVEF 28 ± 7%; end-diastolic volume (EDV) 200±73ml and ESV 145±64ml. GC (n=51) had similar clinical and echocardiographic characteristics (Table 1). SG pts were submitted to CRT implant (37 CRT-P; 23 CRT-D) using the iBox-CRT. There were no immediate complications in the procedure.</p> <p>At 6 months, mean ESV in the EG was 89 ± 44 ml vs 132 ± 75 ml in the CG (p = 0.002) and the EDV 136±51 vs 190±78 (p=0.007). The RR according to the composite outcome was 85.7% in the SG, which was significantly higher compared to the CG (55.9%, p = 0.003). In a sub-analysis with only the responder pts, the LV presented a significantly higher mean LVEF at follow-up (39 ± 11%(SG) vs 37 ± 7% (CG), p = 0.032).</p> <p>Compared with CG, the automatic assessment of acVD-VE with iBox-CRT did not increase fluoroscopy time (15 ± 16min vs 18 ± 16; p = NS) and shortened procedure time (65 ± 34 vs 108 83min, p <0.005).</p> <p><strong>Conclusions: </strong>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 translated into a major increase in CTR response rate, not compromising the procedure duration nor increasing the radiation exposure.</p>
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