RECIPIENT:  Dr. Michael Sweeney
INSTITUTION: Brigham and Women’s Hospital

DESCRIPTION:  Cardiac resynchronization therapy (CRT) is an electrical therapy using multi-site cardiac pacing to re-time the asynchronous contraction sequence of the failing heart on a beat-to-beat basis. Worldwide randomized clinical trials have consistently demonstrated that effective CRT induces reverse ventricular remodeling, which is followed by improvement in pump function (increased ejection fraction, reduced left ventricular size) that translates to improved quality of life, reduced mortality and fewer heart failure hospitalizations.  These beneficial improvements vastly exceed those achieved with medical therapy alone.  Consequently, CRT defibrillators (CRTD) constitute ≥ 40% of all ICDs in the United States. Nonetheless, despite robust large-source randomized clinical trial evidence in support of CRT, clinically meaningful improvement in cardiac pump size and function (“reverse remodeling”) occurs in only 60% of qualifying patients; whereas 30-40% of patients who meet guideline criteria for CRT do not respond to therapy at all, despite a successful procedural outcome and the high cost of implementation.  To date, no method of imaging, hemodynamic assessment, or industry-designed pacemaker automaticity has demonstrated the ability to improve cardiac structural response rates.Independent clinical investigation and mathematical modeling has yielded a method for guiding CRT titration and predicting clinical outcomes on an individual patient basis called the QRS Wave Fusion Method.  This method has successfully identified the key elements of the interaction between fixed myocardial substrate conditions (i.e. natural heart conduction) and the modifiable efficiency of electromechanical resynchronization (i.e. pacing).  Optimum CRT settings (e.g. wave path, mode, timing) are determined using a surface ECG and a computer application guided methodology.  The probability of reverse ventricular remodeling is assessed as part of the process.  The goal of the project is to develop a prototype that will implement the QRS Wave Fusion method for CRT titration and to conduct a clinical evaluation at implant and during routine ambulatory follow-up to tailor the best therapy achievable to the individual patient.