Mechanisms and Innovations in CRT
Research type
Research Study
Full title
Evaluation of Mechanisms and Innovations in Cardiac Resynchronization Therapy
IRAS ID
252384
Contact name
Zachary Whinnett
Contact email
Sponsor organisation
JRCO - Imperial College London and Imperial College Healthcare NHS Trust
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Research Summary
Currently biventricular pacemakers save lives and improve symptoms in patients with heart failure. However, the current way this treatment is delivered may not fully treat the electrical conduction disturbance within the heart which it aims to reverse. Therefore there may be scope for making this treatment even more effective. The clinical studies in this application aim to establish precisely where current therapy is failing and how best to make improvements including the use of a novel method of pacing called His-bundle pacing. His bundle pacing can dramatically improve heart function in some patients with heart failure. It improves function by normalising the electrical conduction of the heart. To bring this technique into wider use we need to develop methods to better identify patients in whom it is likely to be effective.
Summary of Results
In patients with heart failure one of the treatment options is pacing therapy. Patients with a combination of poor heart contraction and disco-ordinated contraction (resulting from abnormal electrical conduction) benefit from pacing therapy. Biventricular pacing is the standard modality. This improves symptoms and reduces hospitalisations and death rates. However, it has a few limitations.
In this project was found that two novel ways to deliver pacing therapy for heart failure, His bundle pacing and left bundle area pacing, are more effective than biventricular pacing. They are better at restoring normal electrical activation of the heart and produce greater improvements in heart function.
Left bundle area pacing has several technical advantages and is equivalent to His bundle pacing in terms of it's ability to restore co-ordinated contraction of the left ventricle and improve acute heart function. Left bundle area pacing has the potential to become the standard pacing method for treating patients with heart failure which may result in better longterm outcomes. These promising results justify performing longer term larger studies to establish whether long-term outcomes are improved.
The outcomes of the study will have the following impact on managing cardiovascular disease in the future.
1) Our findings are very exciting because they suggest that novel pacing methods deliver more effective electrical resynchronisation and acute haemodynamic improvement compared to standard biventricular pacing. This raises the prospect that longer term outcomes for heart failure patients could be improved with these novel treatments. This should now be tested in randomised controlled trials.
2) The findings of our study will guide researchers about how best to program conduction system leads in clinical practice and randomised controlled trials.
3) The findings of our study will improve our ability to best identify patients who will benefit from the new pacing modalities. This will improve patient selection for these novel procedures.
4) The findings of our study help us to identify the technical challenges of delivering left bundle area pacing leads. The results will guide the development of tools that improve lead delivery technology and/or approaches for targeting the conduction system.REC name
Yorkshire & The Humber - Sheffield Research Ethics Committee
REC reference
19/YH/0174
Date of REC Opinion
17 Jul 2019
REC opinion
Further Information Favourable Opinion