CARTBox: Navigating cardiac interventions

Every day cardiologists do their utmost to improve the lives of patients with heart failure. Despite all their efforts there are still many patients for whom standard therapy does not lead to the desired results and who ultimately may need heart transplantation. A therapeutic alternative for these patients is Cardiac Resynchronization Therapy (CRT).
Over the past twenty years CRT, an advanced cardiac pacemaker system, has become standard therapy for patients with heart failure and left ventricular dyssynchrony. During the CRT procedure a pacemaker device with electrodes (leads) is implanted in the heart to restore and improve the impaired contraction of the heart, thereby preventing further decrease of heart function.
The aim of the therapy is to synchronize cardiac contraction by placement of the three leads of the CRT device in the right atrium (RA), right ventricle (RV) and left ventricle (LV) of the heart.
In about 70% of patients undergoing the procedure, CRT results in a more synchronous contraction and a better pump function of the heart and a better prognosis for the patient.
However, despite the overall positive effect, 25-40% of heart failure patients do not benefit from this therapy at all. The main reason is incorrect placement of the stimulation electrode placed in the left ventricle of the heart. In discussions with CRT-implanting cardiologists and in recent literature this is consistently mentioned as the main challenge related to CRT.

Costs of misplacement
The associated global cost of the (partly avoidable) CRT misplacements is currently over €1,4 Billion (cost of the devices alone). Affected patients will have higher hospitalization rates and in the US alone, these patients have treatment-associated costs of >110 Million US$ per annum (without the cost of the devices and placement costs). Procedures to make CRT device placement more accurate and effective will therefore have major health and economic impact.


With its lead medical device product CARTBox, CART-Tech has developed a technology that can extend the benefits of CRT to a larger number of patients (see Technology)

The product has received CE Mark and will be launched in the first European countries in 2019

Impact for the patient

Those patients who do not respond to CRT will continue to suffer from deteriorating heart failure, including:

  • Shortness of breath (dyspnea)
  • Fatigue and weakness
  • Swelling (edema) in the legs, ankles and feet
  • Rapid or irregular heartbeat
  • Reduced ability to exercise.

They will need to visit the hospital more frequently than patients who do respond and have poorer prognosis and life expectancy. In some non-responding patients, CARTBox may be used in the future to find out if the LV lead has been placed in a sub-optimal location and, if so, they may be are eligible for lead repositioning. Prior to CRT placement, the product can be also be used to identify patients who are eligible for the procedure and to exclude those who are unlikely to benefit.

Invited lecture during European Society,
25-29 August, 2018,
Munich in session Expert Advice –
How to integrate imaging in computerized decision support systems in cardiology

Frebus van Slochteren: Prediction of cardiac resynchronisation therapy response by imaging and modeling

To the presentation.

Catheterisation lab, Department of Cardiology,
Utrecht Universty Medical Center