Jain Hritvik, Tariq Muhammad Daoud, Khan Abdul Moiz, Zulfiqar Eeshal, Jain Jyoti, Singh Jagjot, Ahmed Mushood, Shah Siddharth, Patel Nandan, Gardezi Syed Khurram M, Providencia Rui, Ahmed Raheel, Chahal Anwar
From the Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan.
Cardiol Rev. 2025 Mar 26. doi: 10.1097/CRD.0000000000000897.
Heart failure with reduced ejection fraction is a major cause of morbidity and mortality. Cardiac resynchronization therapy (CRT) improves outcomes but faces challenges such as unsuccessful lead placement and suboptimal responses. The Wireless Stimulation Endocardially for CRT (WiSE-CRT) system, a novel leadless left ventricular (LV) pacing technology, uses ultrasonic energy to deliver electrical stimulation directly to the LV endocardium, potentially improving the response rates. A comprehensive literature search was performed across multiple databases from inception until August 2024. The outcomes of interest included the New York Heart Association (NYHA) functional score, LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and QRS duration. Statistical analysis involved pooling the mean differences (MDs) and their corresponding 95% confidence intervals (CIs) from each study using the inverse-variance random-effects model in RevMan version 5.4.1 software. Seven studies, including 468 patients with heart failure treated with the WiSE-CRT system, were included. The pooled analysis showed significant improvements in NYHA functional score (MD: -0.44; 95% CI: -0.67 to -0.21; P = 0.0002; I2 = 77%), LVEF (MD: 5.71; 95% CI: 4.54 to 6.87; P < 0.001), LVEDV (MD: -24.49; 95% CI: -33.24 to -15.73; P < 0.001), and LVESV (MD: -24.47; 95% CI: -32.80 to -16.14; P < 0.001). The QRS duration also decreased significantly (MD: -38.62; 95% CI: -46.76 to -30.49; P < 0.001; I2 = 60%). The WiSE-CRT system significantly improved NYHA functional score, LVEF, QRS duration, LVEDV, and LVESV in patients with heart failure. This leadless pacing technology offers a promising alternative for ineligible candidates or for those who do not respond to conventional CRT.
射血分数降低的心力衰竭是发病和死亡的主要原因。心脏再同步治疗（CRT）可改善预后，但面临诸如导线植入失败和反应欠佳等挑战。用于CRT的无线心内膜刺激（WiSE-CRT）系统是一种新型的无导线左心室起搏技术，它利用超声能量将电刺激直接传递至左心室心内膜，有可能提高反应率。从数据库建立至2024年8月进行了全面的文献检索。感兴趣的结局包括纽约心脏协会（NYHA）功能分级、左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和QRS时限。统计分析采用RevMan 5.4.1软件中的逆方差随机效应模型汇总每项研究的平均差值（MD）及其相应的95%置信区间（CI）。纳入了7项研究，包括468例接受WiSE-CRT系统治疗的心力衰竭患者。汇总分析显示，NYHA功能分级（MD：-0.44；95%CI：-0.67至-0.21；P=0.0002；I2=77%）、LVEF（MD：5.71；95%CI：4.54至6.87；P<0.001）、LVEDV（MD：-24.49；95%CI：-33.24至-15.73；P<0.001）和LVESV（MD：-24.47；95%CI：-32.80至-16.14；P<0.001）均有显著改善。QRS时限也显著缩短（MD：-38.62；95%CI：-46.76至-30.49；P<0.001；I2=60%）。WiSE-CRT系统显著改善了心力衰竭患者的NYHA功能分级、LVEF、QRS时限、LVEDV和LVESV。这种无导线起搏技术为不符合条件的患者或对传统CRT无反应的患者提供了一种有前景的替代方案。
