Pacertool Early Feasibility Study - Safety and Performance

The study is a non-randomized, two-part, open label, prospective single-site, single arm, safety and performance study. The study is designed to collect acute and long-term clinical data and user reported outcome data from using the PreSens-Catheter and PACER Software during cardiac catheterization and Cardiac Resynchronization Therapy (CRT) device implantation procedures. Subjects with indication for arterial catheterization and CRT will be included.

The study consists of two parts:

1. Initial safety assessment: at least 5 patients undergoing coronary angiography or left heart catheterization and 5 patients undergoing cardiac resynchronization therapy device implantation to demonstrate acute safety and performance of the PreSens-Catheter and the PACER Software for Td measurements.
2. Safety and performance assessment: At least 35 patients with an indication for CRT implantation according to standard of care to demonstrate acute safety and performance of using the PreSens-Catheter and the PACER Software to measure Td and detect Synergy and Dyssynergy from multisite stimulation, and its utility to deliver measurements for the discrimination of two clinical cardiac reverse volumetric remodeling phenotypes based on Synergy and Dyssynergy in the targeted population.

Subjects will be followed for the duration of the procedure up to 24 hours for any serious adverse events, and subjects receiving a CRT device will be followed for 30 days follow-up for procedure or device-related events and for up to 6 months for cardiac volumetric remodeling phenotyping.

Clinical outcomes: Clinical outcome will be measured as Safety for the placement of the PreSens-Catheter, safety for the PreSens-Catheter and PACER Software combined for the measurement of Td and detection of Synergy/ Dyssynergy from stimulation, and diagnostic/ predictive performance of the PreSens-Catheter and PACER Software with the measurement of end-systolic volume at 6-months follow-up.

Eligibility Criteria:
Inclusion Criteria:

Part I:

* Subject has an indication for coronary angiography or left heart catheterization or cardiac resynchronization therapy.
* QRS duration between 90-150ms.
* Subject is ≥ 18 years old.
* Willingness, ability, and commitment to participate in baseline and follow-up evaluations for the full duration of the clinical study.
* Willing and able to give informed consent.

Part II:

* Subject in sinus rhythm with an indication for implantation of a Cardiac Resynchronization Device (Appendix I)
* NYHA Class II-IV (Ambulatory IV)
* EF\<35%
* QRS duration \>120ms.
* Subject is ≥ 18 years old.
* Willingness, ability, and commitment to participate in baseline and follow-up evaluations for the full duration of the clinical study.
* Willing and able to give informed consent.

Exclusion Criteria:¨

* Subject has unstable angina/ acute coronary ischemia/ infarction
* Previous myocardial infraction (\<6 months)
* History of blood clothing or bleeding disease
* Prior history of documented cerebral infarction, TIA or systemic embolism (excluding a postoperative DVT)
* Subject has an arterial unstable aneurysm
* Subject has severe peripheral vascular disease
* Subject has an artificial aortic or mitral valve replacement
* Subject has severe aortic valve disease
* Subject has a clinically significant infection (bacteriemia or sepsis)
* Subject has contraindications to anticoagulation
* Patients with a serious allergy to drugs necessary for the procedure such as anticoagulants and protamine
* Subject has left atrial/ ventricular thrombus
* Patients with severe vascular obstructions in the desired/ presumed insertion path of the catheter
* Significant or symptomatic hypotension
* NYHA class IV (hospitalized), severe circulation instability or shock
* Ongoing/ persistent atrial arrythmias
* History of Rheumatic fever
* Subject has sensitivity to contrast media
* Contraindications to CT or fluoroscopy
* Distorted cardiac anatomy due to congenital heart disease
* Pregnant or possibly pregnant
* Not eligible for thoracotomy procedures
* Life expectancy \<1 years
* Any other condition that, in the judgement of the investigator, makes the subject a poor candidate for this procedure, the study or compliance with the protocol (includes addictive disease, extensive travel away from the research center)
* Clinically significant psychological condition that in the investigator's opinion would prohibit the subject's ability to meet the protocol requirements
* Current enrollment in any other study protocol where testing or results from that study may interfere with the procedure or outcome measurements of this study