Key result
Leadless LV endocardial pacing achieves ~51% echocardiographic response in conventional CRT non-responders.
Why the study?
Non-responders to conventional coronary sinus CRT have limited treatment options, but whether leadless LV endocardial pacing using the WiSE-CRT system provides efficacy in this population was unknown.
Does leadless left ventricular endocardial pacing using the WiSE-CRT system improve echocardiographic and clinical outcomes in heart failure patients who are non-responders to conventional CRT?
Observational (n=71)
Yes
Does leadless left ventricular endocardial pacing using the WiSE-CRT system improve echocardiographic and clinical outcomes in heart failure patients who are non-responders to conventional CRT?
Leadless left ventricular endocardial pacing provides a viable second-line treatment option for conventional CRT non-responders, with the degree of QRS narrowing serving as a strong predictor of echocardiographic response.
Answers are grounded in this paper and cite their sources.
May offer pacing option for CRT non-responders; leaves open need for randomized confirmation before practice change.
BACKGROUND: Non-responders to conventional coronary sinus CRT represent a high-risk heart failure population with limited treatment options. Leadless LV endocardial pacing may provide benefit by delivering more physiological activation patterns, and enabling pacing from optimized LV cavity sites. We aimed to evaluate the efficacy of leadless endocardial pacing using the WiSE-CRT system in CRT non-responders. METHODS: A pooled patient-level post-hoc analysis of the SELECT-LV study, the WiSE Post-Market Registry and the SOLVE-CRT trial was performed. Multivariable regression analysis identified predictors of response to WiSE-CRT, followed by ROC analysis and subgroup analysis by degree of QRS narrowing. RESULTS: The total cohort comprised of 71 patients. Complete echocardiographic data was available in 66 patients, and complete ECG data available in 45 patients. The clinical response rate (improvement in at least one NYHA class) was 46%. The "combined echocardiographic response rate" (composite of reduction in LV end-systolic volume of ≥15% or improvement in LV ejection fraction of ≥5%) was 51%. The degree of QRS reduction with WiSE-CRT compared to standard CRT was an independent predictor of combined echocardiographic response. ROC analysis generated an AUC of 0.68, with a Youden index cut-off of 19ms reduction in QRS. Subgroup analysis revealed a combined echocardiographic response rate of 70.5% above the cut-off and 38.5% below p = 0.04). CONCLUSION: Leadless endocardial CRT is a viable treatment option for conventional CRT non-responders. The degree of QRS narrowing with LV endocardial stimulation is predictive of response. Optimizing QRS reduction when testing LV pacing sites may be beneficial in maximizing outcomes.
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Wijesuriya et al. (2025) conducted an observational in Heart failure non-responsive to conventional cardiac resynchronization therapy (n=71). Leadless left ventricular endocardial pacing (WiSE-CRT) vs. Baseline (conventional CRT) was evaluated on Combined echocardiographic response (reduction in LV end-systolic volume ≥15% or improvement in LV ejection fraction ≥5%). Leadless left ventricular endocardial pacing achieved a combined echocardiographic response rate of 51% and a clinical response rate of 46% in patients who were non-responders to conventional cardiac resynchronization therapy.
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