Going inside the heart to make pacemakers benefit more people with heart failure

Identifying the optimal location for LV endocardial lead placement in CRT delivery using cardiac magnetic resonance imaging, acute hemodynamic response and non-invasive electro-anatomical mapping

Cardiac Resynchronisation Therapy (CRT) is a procedure that’s commonly used in patients with heart failure, which occurs when the heart is not pumping blood around the body as well as it should. This happens most commonly when the heart muscle has been damaged – for example, after a heart attack. During CRT tiny leads are positioned on the pumping chambers of the heart (ventricles). They monitor the heart beat for irregularities and then send out electrical pulses to the ventricles to make them beat in a more synchronised way. However, a large proportion of patients – up to 40 per cent – don’t experience much or any improvement from it. Conventionally, the pacemaker leads are positioned on the outside of the heart. Professor Reza Razavi and colleagues will examine whether placing a lead on the inner surface of the ventricle is more effective. They will test different positions for lead placement and assess how to find the best position. Over half a million people in the UK have been diagnosed with heart failure. The condition can be debilitating and distressing, but when CRT works it can improve symptoms and quality of life. This team hope that by harnessing the potential of pacing the inner surface of the heart, CRT could make a difference to more patients.