Making sure pacemakers deliver the maximum benefit for heart failure patients

Clinical outcome study (using exercise capacity) to assess equivalence of non-invasive haemodynamic optimisation to echo optimisation of CRT devices

Heart failure is a condition where the heart becomes less effective at pumping blood. In some people who have heart failure, the left and right sides of the heart don’t beat in time with each other. This condition – called ‘desynchronicity’ – impairs the working of the heart and makes symptoms worse. Many heart failure patients who have this problem are given a type of treatment called cardiac resynchronisation therapy, which involves having a special type of pacemaker implanted in their chest. This treatment tends to improve the patient’s symptoms and reduce the likelihood of them having to return to hospital. The settings on these devices can be adjusted to give maximum benefit to the individual patient, but the procedure for finding the ideal settings by measuring the heart’s electrical activity is time-consuming, and only around half of patients have this done. Dr Darrell Francis and his team have developed a new way to optimise the settings on the pacemaker, based on measuring the blood pressure in the person’s finger. This method is quick and simple to perform and causes little inconvenience to the patient. This project will test whether this new optimisation procedure delivers similar results to the standard method. The researchers will look at 400 people who already have cardiac resynchronisation devices implanted. Each one will have their settings optimised for a six month period with each procedure, and their exercise capacity will be tested. If the new method proves to work just as well as the more time-consuming method, it will mean that doctors can more easily make sure that pacemakers are set up to give heart failure patients the best possible improvements in their symptoms.