NEW TECHNOLOGIES TO IMPROVE CRT OUTCOME


Karlheinz Seidl, M.D., Klinikum Ingolstadt, Germany

CRT has evolved as an established treatment for advanced heart failure symptoms, impaired LV function and intraventricular conduction delay despite substantial improvement in technology and optimization techniques 30% - 40% of pts fail to gain significant clinical benefit. What are the clinical challenges? 1. Venous System Access (inabilitiy to cannulate, pass the LV lead in a CS branch) 2. Maintaining Lead Stability (dislogement rate 6-14 %. 3. Non-Optimal Pacing Site (unsatisfactory pacing parameters.4. High Pacing Threshold.5. Phrenic Nerve Stimulation.( PNS; 37% PNS detected, 22% clinical relevant; posture dependent, detection of PNS at implantation poor sensitivity, occurs up to 22 % at pacing sites most associated with reverse remodeling). New Technologies are needed to increase implantation success. One of the most advantages was the development of a quadripolar left ventricular lead. Quadripolar lead technology allows pacing options over 5 cm on the left ventricle, facilitates Quadripolar multisite LV and RV pacing.CRT with the Quartet™ LV Lead Improves Implant Efficiency( lead implant times were 28% faster, fluoroscopic exposure 55% lower, implantation success > 95% , low rates of dislocation and PNS (4.5% vs 26%). Therefore rehospitalization/reinterventions is reduced with lower rehospitalizations rates and reduced costs. Pacing site is crucial for improving ventricular mechanics. Basal or midventricluar pacing site better than apical. Multipolar lead may facilitate targeting of more proximal CS branches (targeting more basal or mid ventricular pacing sites).May reduce nonresponder rate (more choice, avoinding scar tissue pacing). Avoid PNS. More choice of the best performing pacing configuration and by enhancing to achieve a stable lead position at good target position. More solutions to common problems faced by physicans during implantation and FU