QUARTERMASTER

• Research type

  Research Study

• Full title

  Quartet Lead with Defibrillator Multisite Algorithmic Cardiac Resynchronisation Therapy Optimisation

• IRAS ID

  186610

• Contact name

  Zaheer Yousef

• Contact email

  zaheer.yousef@wales.nhs.uk

• Sponsor organisation

  Cardiff and Vale University Local Health Board

• Duration of Study in the UK

  1 years, 3 months, 1 days

• Research summary

  A prospective, single-centre study of algorithmic optimisation in cardiac resynchronisation therapy using multi-site pacing

  Background
  Cardiac resynchronisation therapy (CRT) improves outcomes and symptoms in selected patients with heart failure. However, around one third of suitable patients do not demonstrate benefit following device implantation when assessed by echocardiography (heart scanning). This group has poorer outcomes.

  Response rate can be enhanced by altering timing delays between the pacing leads, but some patients still fail to improve.

  Quadripolar left ventricular leads are now widely used in CRT. The lead’s four poles increase the number of conformations available to the programmer, allowing multiple vectors to be programmed simultaneously or sequentially. This allows programming to avoid, for example, a patch of scar and find an area that will respond better to pacing. This technique is known as multi-site pacing. CRT is often implanted along with a defibrillator lead in the right ventricle, known as CRT-D. The defibrillator lead offers further combinations for pacing.

  Goal of Research
  To evaluate an algorithm for assessing different multi-site pacing combinations in optimisation of CRT

  Outline
  We will recruit 36 consecutive patients undergoing CRT-D implantation for conventional indications at our hospital. At baseline, we will perform echocardiography, exercise testing and assess functional ability and quality of life. The device will be implanted as standard. Optimisation will be performed with an algorithm using different vector combinations and assessing the heart’s efficiency through echocardiography and invasive pressure monitoring. The pacemaker will be programmed with standard settings. After twelve weeks, the baseline investigations and optimisation algorithm will be repeated and the device programmed according to the maximum efficiency. After a further 12 weeks, the same parameters will be measured to look for improved response to CRT.

  Potential Benefit
  To increase the response rate to cardiac resynchronisation therapy and improve reliability of the technique

• REC name

  Wales REC 7

• REC reference

  16/WA/0370

• Date of REC Opinion

  30 Nov 2016

• REC opinion

  Favourable Opinion