Cardiac Resynchronization Therapy


The aim of this work package is to define acute response parameters that can be used to optimize cardiac resynchronization therapy (CRT). With the current worldwide empiric implantation practice of CRT, a 50-60% responder rate is expected. Through clinical studies and innovative study design novel acute response parameters are investigated in order to pick optimal response parameters that can be used to characterize cardiac electric, mechanic and tissue properties to predict long-term response of CRT. Furthermore, different pacing configurations will be assessed and compared. An important work of this group is the development of the Pacertool and the transition of this tool into clinical practice.


SELECTED PROJECTS

CCI Impact study

This study was completed in 2015. Results will be published in 2016-2018. In the CCI IMPACT study, OUH and Medtronic try to leverage on all recent advances within the field of CRT research. The PATIENT SELECTION process has shifted from a mere HF treatment focus to a more proactive approach, where CRT is used to prevent HF progression in mildly symptomatic patients or patients in need of cardiac pacing. Appropriate patient selection is essential to achieving CRT therapy success, and OUH has taken a leading role in developing consensus documents which comment, summarize and endorse the most current European and US guidelines for CRT. When the appropriate patient is selected for CRT, we need to streamline the pre-planning phase. The other research partners, GEVU and Simula, have and will continue to work on the collected imaging data (cMR and Echo) to find the optimal way of presenting crucial patient-specific information to the implanting physician before he/she enters the operation room.

The CCI IMPACT study was designed to give insight to the CRT IMPLANT procedure. Enrollments are finished and the data analysis has started. We hope the results will help us to better understand the acute mechanisms at play during device delivered resynchronization therapy. There are several factors that may affect the final LV lead location: varied venous anatomies, LV lead delivery and stability challenges, presence of phrenic nerve stimulation and high LV pacing thresholds. There is an unmet need of a parameter quantifying and/or confirming acceptable therapy delivery at any given lead position, and the CCI Impact study will assess the predictive properties of a set carefully selected parameters.

 

Pacertool-project

The Pacertool-project has received funding through the Biotek2021 program and will continue as a stand-alone project outside the WP4, however with close collaboration into the WP4. The Pacertool-project includes both development of hardware and software in a clinical system for use during implantation of CRT. The system will provide feedback to the operator when implanting a cardiac resynchronization device (CRT) and represents the interface between measured parameters and the operator. The aim of this system is to improve the current 50-60% responder rate of CRT.

The pacertool software will allow the implanter to individualize pacing lead positions to optimize the resynchronization effect of the CRT device. Parameters that are measured during implantation will be collected and displayed to highlight the optimal site of electrode placement. Imaging from pre-implantation studies, as echocardiography and magnetic resonance imaging can be incorporated to display patient-specific cardiac geometry. When coronary sinus angiography is performed during the implantation procedure, the patient-specific anatomy can be segmented and utilized during the procedure. When incorporated in research different positioning can be compared and analyzed.

The data from any procedure can be used for predictive patient-specific simulation Data collected from every patient is stored together with geometry. This will allow for validation of simulation algorithms and for calculating predictive reverse remodeling.

When performed during the implantation procedure, optimal sites for lead placement can be highlighted and compared to acute study hemodynamic parameters. This may provide validity to the simulation protocol and possibly provide insight into patient-specific reverse remodeling processes.

 


A geometrical model of Pacertool.

Heart SFI