The CRM group’s principal research interests are the treatment of abnormal heart rhythms and the resynchronisation of abnormal electrical conduction in heart failure patients. There is a particular focus on the use of novel and emerging technologies.
Atrial fibrillation (AF) is a common heart rhythm disturbance that can cause significant morbidity and mortality. Catheter ablation has emerged as a valid therapy but little is understood about the underlying substrate, the mechanism by which ablation exerts its effects and how to tailor therapy to individuals. As with any invasive treatment, safety should be paramount. The CRM group is involved in investigator-led and commercial multicentre trials on AF ablation that use novel technologies to guide ablation strategies. Oxford is one of a handful of European centres using the Acutus Medical AcQMap system to map atrial fibrillation in real time to identify potential target sites within the left atrium, such as areas of rotational activity or repetitive firing, that contribute to AF maintenance. Investigator-led studies are underway to find the optimal way to image and assess peri-procedure ablation lesion formation. The CRM team is also researching into optimal power delivery to maximise ablation efficacy whilst minimising the risk of collateral damage to adjacent structure, such as the oesophagus.
Complimentary to this, the CRM team has also contributed to the knowledge base behind percutaneous left atrial appendage occlusion, a novel device therapy to reduce the risk of AF-related thromboembolic stroke.
Another major area of research is cardiac resynchronisation therapy for patients with heart failure, impaired left ventricular systolic function and underlying conduction abnormalities that manifest as dyssynchrony. Although biventricular pacing using conventional technologies has been available for 20 years, it is only effective for approximately 60-70% of people treated. There are anatomical and physiological challenges that may be overcome using novel approaches. Left ventricular endocardial pacing offers many theoretical advantages and the CRM team are involved in investigator-led and commercial studies utilising novel software algorithms (MORE CRT MPP) and ultrasound-based LV stimulation (EBR Solutions WiCS system). The team in Oxford has developed a novel approach to left ventricular lead delivery (the ventricular transseptal approach) to offer treatment to those in whom the conventional approach has failed. This body of work won the Heart Rhythm Congress Young Investigators Award in 2016.
The CRM Team is led by Dr Tim Betts, Consultant Cardiologist. At any one time there are one or two Research Fellows who are Cardiologists in Training. There is also a highly experienced and dedicated Research Team comprising six whole time equivalent Research Nurses, Research Coordinators and Data Coordinators.
The CRM Research Team has collaborated with other Oxford Cardiovascular groups, primarily OCMR, with CRM groups from other BRC institutions (Guy’s and St Thomas’) and NHS teams as well as a number of industry partners (Abbott, St Jude Medical, Boston Scientific, Medtronic, Acutus Medical, EBR Systems etc). Collaborations currently in development include projects in the Oxford University Department of Physiology, Anatomy and Genetics.
Dr Betts is UK PI and on the steering committee for the international EWOLUTION registry of >1000 patients receiving the Watchman left atrial appendage occlusion device. Published August 2016.
Dr Betts is on the steering committee for CASA-AF, an investigator-led NIHR portfolio trial comparing surgical to percutaneous ablation for atrial fibrillation.
Dr Betts is UK PI for ASAP-TOO, an international multicentre RCT on left atrial appendage occlusion sponsored by Boston Scientific.