Guidance for Optimal Site Selection of a Leadless Left Ventricular Endocardial Electrode Improves Acute Hemodynamic Response and Chronic Remodeling

Sieniewicz, Benjamin; Behar, Jonathan M.; Gould, Justin; Claridge, Simon; Porter, Bradley; Sidhu, Baldeep S.; Niederer, S; Betts, Timothy R.; Webster, D C; James, Simon; Turley, Andrew; Rinaldi, Christopher Aldo

doi:10.1016/j.jacep.2018.03.011

Cited by 21 publications

(18 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the pursuit of leadless CRTs, the WiSE CRT system (EBR Systems, Inc.) has recently been launched in a clinical trial 34,35 . The current embodiment of this technology requires the use of a standard dual-chamber pacemaker with only the LV wirelessly paced via ultrasound power transfer, thus limiting the potential benefits of leadless pacing.…”

Section: Discussionmentioning

confidence: 99%

Synchronized Biventricular Heart Pacing in a Closed-chest Porcine Model based on Wirelessly Powered Leadless Pacemakers

Lyu

John²,

Burkland

et al. 2020

Sci Rep

View full text Add to dashboard Cite

About 30% of patients with impaired cardiac function have ventricular dyssynchrony and seek cardiac resynchronization therapy (CRT). In this study, we demonstrate synchronized biventricular (BiV) pacing in a leadless fashion by implementing miniaturized and wirelessly powered pacemakers. With their flexible form factors, two pacemakers were implanted epicardially on the right and left ventricles of a porcine model and were inductively powered at 13.56 MHz and 40.68 MHz industrial, scientific, and medical (ISM) bands, respectively. The power consumption of these pacemakers is reduced to µW-level by a novel integrated circuit design, which considerably extends the maximum operating distance. Leadless BiV pacing is demonstrated for the first time in both open-chest and closed-chest porcine settings. The clinical outcomes associated with different interventricular delays are verified through electrophysiologic and hemodynamic responses. The closed-chest pacing only requires the external source power of 0.3 W and 0.8 W at 13.56 MHz and 40.68 MHz, respectively, which leads to specific absorption rates (SARs) 2-3 orders of magnitude lower than the safety regulation limit. This work serves as a basis for future wirelessly powered leadless pacemakers that address various cardiac resynchronization challenges.

show abstract

Section: Discussionmentioning

confidence: 99%

Synchronized Biventricular Heart Pacing in a Closed-chest Porcine Model based on Wirelessly Powered Leadless Pacemakers

Lyu

John²,

Burkland

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Given that CRT nonresponders are an already difficult group who are perhaps less likely to respond, the ability to choose from any pacing location is extremely vital in improving outcomes and is an important benefit with the WiSE-CRT system. 13 Endocardial pacing places patients at additional risks related to the procedure and thromboembolic events, with the later an ongoing risk with trans-septal leads requiring lifelong anticoagulation. 9 The WiSE-CRT system uses leadless pacing, which may reduce this long-term thromboembolic risk.…”

Section: Comparison With Prior Studiesmentioning

confidence: 99%

Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy

Sidhu

Porter

Gould

et al. 2020

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

Background Endocardial pacing may be beneficial in patients who fail to improve following conventional epicardial cardiac resynchronization therapy (CRT). The potential to pace anywhere inside the left ventricle thus avoiding myocardial scar and targeting the latest activating segments may be particularly important. The WiSE‐CRT system (EBR systems, Sunnyvale, CA) reliably produces wireless, endocardial left ventricular (LV) pacing. The purpose of this analysis was to determine whether this system improved symptoms or led to LV remodeling in patients who were nonresponders to conventional CRT. Method An international, multicenter registry of patients who were nonresponders to conventional CRT and underwent implantation with the WiSE‐CRT system was collected. Results Twenty‐two patients were included; 20 patients underwent successful implantation with confirmation of endocardial biventricular pacing and in 2 patients, there was a failure of electrode capture. Eighteen patients proceeded to 6‐month follow‐up; endocardial pacing resulted in a significant reduction in QRS duration compared with intrinsic QRS duration (26.6 ± 24.4 ms; P = .002) and improvement in left ventricular ejection fraction (LVEF) (4.7 ± 7.9%; P = .021). The mean reduction in left ventricular end‐diastolic volume was 8.3 ± 42.3 cm3 (P = .458) and left ventricular end‐systolic volume (LVESV) was 13.1 ± 44.3 cm3 (P = .271), which were statistically nonsignificant. Overall, 55.6% of patients had improvement in their clinical composite score and 66.7% had a reduction in LVESV ≥15% and/or absolute improvement in LVEF ≥5%. Conclusion Nonresponders to conventional CRT have few remaining treatment options. We have shown in this high‐risk patient group that the WiSE‐CRT system results in improvement in their clinical composite scores and leads to LV remodeling.

show abstract

“…8 The wireless LV electrode delivery system allows different areas of the left ventricle to be mapped for preferential pacing positions before implantation. Guidance for optimal site selection has recently been proposed from a study at 3 sites 11 and has the potential to further improve implant success.…”

Section: Endocardial Vs Epicardial LV Pacingmentioning

confidence: 99%

Successful implementation of a totally leadless biventricular pacing approach

Funasako

Neužil

Dujka

et al. 2020

HeartRhythm Case Reports

View full text Add to dashboard Cite

Guidance for Optimal Site Selection of a Leadless Left Ventricular Endocardial Electrode Improves Acute Hemodynamic Response and Chronic Remodeling

Abstract: Guided endocardial implants were associated with a higher degree of chronic LV remodeling compared with historical nonguided approaches.

Cited by 21 publications

References 26 publications

Synchronized Biventricular Heart Pacing in a Closed-chest Porcine Model based on Wirelessly Powered Leadless Pacemakers

Synchronized Biventricular Heart Pacing in a Closed-chest Porcine Model based on Wirelessly Powered Leadless Pacemakers

Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy

Successful implementation of a totally leadless biventricular pacing approach

Contact Info

Product

Resources

About