Kardiale Device Therapie

Research focus

Our team of physicans and allied health professionals including clinical cardiac physiologists and nurses and administrative staff is dedicated to answering questions of relevance to patients and their carers within a rounded and comprehensive research program embedded within a device service that offers optimal personalised medical and device therapy to people with symptoms due to heart failure.

Focus of the working group:

  • Heart rate
  • Exercise capacity
  • Personalization of programming
  • Cardiac resynchronization therapy
  • Mitral regurgitation in heart failure
Group leader



Priv.-Doz. Dr. med. Andreas Napp

Dr. med. Rosalia Dettori

Marcel Kurzeja

Swenja Hesterberg

Michael Holzbach

Annsophie Schmitz

Ralph Herpertz

  • Mapping the metabolome of heart rate
    This project will describe the metabolic adaptations that accompany changes in heart rate in patients with and without heart failure. Using a unique approach and in collaboration with our partners in the Leeds Institute for Cardiovascular and Metabolic Medicine we hope to discover the pathophysiology that underlies the failing force frequency relationship in heart failure as a first step in restoring this critical physiological response and thereby improving exercise capacity.
  • RVA/RVS/LBBA – does it make a difference and why?
    This project will attempt to explore whether there are any significant differences between the three commonest right ventricular lead positions in terms of medium term cardiac remodelling and myocardial work to document the contemporary risks and benefits of each with the long term aim of personalising the hardware delivery approach to the patient.
  • Airways resistance in heart failure: the effect of CRT
    Persistent breathlessness is a common problem for people with heart failure and some of it may stem from the lungs where back-pressure from the weakened heart can lead to swelling of the small vessels. A new piece of equipment can diagnose and measure this. The present study is a collaboration between the cardiology and the respiratory service and, by  determining whether the improved haemodynamics reduce airways resistance will provide mechanistic insights with the long term view of optimising and personalising therapy accordingly to ease the breathlessness associated with heart failure.
  • The influence of mitral annuloplasty on the efficacy of pulmonary vein isoltation for atrial fibrillation: MASTER-AF
    Pulmonary vein isolation for atrial fibrillation (AF) has become one of the most commonly performed invasive procedures. Restoration of sinus rhythm is associated with benefits on quality of life and exercise capacity. However, up to half of all patients treated have a reversion to AF within a year and require further treatment. This is most common in those with structural heart disease including mitral regurgitation. The present study, which is supported by an industrial partnership with Cardiac Dimensions and Medtronic, will determine whether reducing mitral regurgitation prior to the ablation can improve the restoration and maintenance of sinus rhythm.

Straw S, Gupta A, Johnson K, Cole CA, Kneizeh K, Gierula J, Kearney MT, Malkin CJ, Paton MF, Witte KK, Schlosshan D. Atrial secondary mitral regurgitation: prevalence, characteristics, management, and long-term outcomes. Echo Res Pract 2023;10:4. doi: 10.1186/s44156-023-00015-y. PMID: 36882790

Straw S, Witte KK. Remote monitoring in heart failure: it's the data you collect and what you do with them. Heart 2023:heartjnl-2022-322137. doi: 10.1136/heartjnl-2022-322137. PMID: 36702540

Elkind MSV, Witte KK, Kasner SE, Sawyer LM, Grimsey Jones FW, Rinciog C, Tsintzos S, Rosemas SC, Lanctin D, Ziegler PD, Reynolds MR. Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the US. BMC Cardiovasc Disord 2023;23:45. doi: 10.1186/s12872-023-03073-6.PMID: 36698055

Schick D, Straw S, Witte KK, Napp A. Palliativversorgung bei Herzinsuffizienz. Zeitschrift für Palliativmedizin 2022;23:327-344
DOI: 10.1055/a-1675-0747

Berger M, Kumowski N, Straw S, Verket M, Marx N, Witte KK, Schütt K. Clinical implications and risk factors for QRS prolongation over time in heart failure patients. Clin Res Cardiol 2023;112:312-322. doi: 10.1007/s00392-022-02122-y. Epub 2022 Nov 15.PMID: 3637829

Sundaram V, Zakeri R, Witte KK, Quint JK. Development of algorithms for determining heart failure with reduced and preserved ejection fraction using nationwide electronic healthcare records in the UK. Open Heart 2022;9:e002142. doi: 10.1136/openhrt-2022-002142.PMID: 36332942

Straw S, Napp A, Witte KK. 'Acute Heart Failure': Should We Abandon the Term Altogether? Curr Heart Fail Rep 2022;19:425-434. doi: 10.1007/s11897-022-00576-9. PMID: 36166184

Witte KK, Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Fonseca C, Lonn E, Noè A, Schwende H, Butylin D, Chiang Y, Pascual-Figal D; TRANSITION investigators. Influence of diabetes on sacubitril/valsartan titration and clinical outcomes in patients hospitalized for heart failure. ESC Heart Fail 2023;10:80-89. doi: 10.1002/ehf2.14166. PMID: 36125177

Gierula J, Cole CA, Drozd M, Lowry JE, Straw S, Slater TA, Paton MF, Byrom RJ, Garland E, Halliday G, Winsor S, Lyall GK, Birch K, McGinlay M, Sunley E, Grant PJ, Wessels DH, Ketiar EM, Witte KK, Cubbon RM, Kearney MT. Atrial fibrillation and risk of progressive heart failure in patients with preserved ejection fraction heart failure. ESC Heart Fail 2022;9:3254-3263. doi: 10.1002/ehf2.14004. PMID: 35790085

Straw S, Cole CA, McGinlay M, Drozd M, Slater TA, Lowry JE, Paton MF, Levelt E, Cubbon RM, Kearney MT, Witte KK, Gierula J. Guideline-directed medical therapy is similarly effective in heart failure with mildly reduced ejection fraction. Clin Res Cardiol 2023;112:111-122. doi: 10.1007/s00392-022-02053-8. PMID: 35781605

Drozd M, Pujades-Rodriguez M, Morgan AW, Lillie PJ, Witte KK, Kearney MT, Cubbon RM. Systemic Inflammation Is Associated With Future Risk of Fatal Infection: An Observational Cohort Study. J Infect Dis 2022;226:554-562. doi: 10.1093/infdis/jiac186. PMID: 35535512

Straw S, Gierula J, Witte KK. Designing clinical trials in heart failure with preserved ejection fraction: quality over quantity? Eur J Heart Fail 2022;24:851-854. doi: 10.1002/ejhf.2510. PMID: 35445788

Straw S, Mullens W, Witte KK. Cardiac resynchronisation therapy with or without a defibrillator: individualising device prescription. Heart 2022;108:1164-1166. doi: 10.1136/heartjnl-2022-320909.PMID: 3541089
McNally BD, Ashley DF, Hänschke L, Daou HN, Watt NT, Murfitt SA, MacCannell ADV, Whitehead A, Bowen TS, Sanders FWB, Vacca M, Witte KK, Davies GR, Bauer R, Griffin JL, Roberts LD. Long-chain ceramides are cell non-autonomous signals linking lipotoxicity to endoplasmic reticulum stress in skeletal muscle. Nat Commun 2022;13:1748. doi: 10.1038/s41467-022-29363-9.PMID: 35365625

Claxton L, Simmonds M, Beresford L, Cubbon R, Dayer M, Gottlieb SS, Hartshorne-Evans N, Kilroy B, Llewellyn A, Rothery C, Sharif S, Tierney JF, Witte KK, Wright K, Stewart LA. Coenzyme Q10 to manage chronic heart failure with a reduced ejection fraction: a systematic review and economic evaluation. Health Technol Assess 2022;26:1-128. doi: 10.3310/KVOU6959.PMID: 35076012

Witte KK, Kaye DM, Lipiecki J, Siminiak T, Goldberg SL, von Bardeleben RS, Sievert H, Levy W, Starling RC. Treating symptoms and reversing remodeling: clinical and echocardiographic 1-Year outcomes with percutaneous mitral valve annuloplasty for mild to moderate secondary mitral regurgitation. Eur J Heart Fail 2021;23:1971-1978

Straw S, McGinlay M, Gierula J, Lowry JE, Paton MF, Cole C, Drozd M, Koshy AO, Mullens W, Cubbon RM, Kearney MT, Witte KK. Impact of QRS duration on left ventricular remodelling and survival in patients with heart failure. J Cardiovasc Med 2021;22:848-856

McGinlay M, Straw S, Byrom-Goulthorp R, Gierula J, Cubbon RM, Kearney MT, Witte KK. Optimal dosing of β-blockers in chronic heart failure: a missed opportunity? J Cardiovasc Nursing 2021 in press

MacCannell A, Futers S, Whitehead A, Moran A, Witte KK, Roberts LD. Sexual dimorphism in adipose tissue mitochondrial function and metabolic flexibility in obesity. Int J Obesity 2021;45:1773-1781. doi: 10.1038/s41366-021-00843-0.

Witte KK, Tsivgoulis G, Reynolds MR, Tsintzos SI, Eggington S, Ismyrloglou E, Lyon J, Huynh M, Egea M, de Brouwer B, Ziegler PD, Franco N, Joglekar R, Rosemas SC, Liu S, Thijs V. Burden of oral anticoagulation in embolic stroke of undetermined source without atrial fibrillation. BMC Cardiovasc Dis 2021;21:160

Knuiman P, Straw S, Gierula J, Koshy AO, Roberts LD, Witte KK, Ferguson C, Bowen TSE. Quantifying the relationship and contribution of mitochondrial respiration to systemic exercise limitation in heart failure. ESC Heart Failure 2021;8:898-907

Saunderson C, Paton MF, Brown L, Gierula J, Chew PG, Das A, Sengupta A, Craven T, Chowdhary A, Koshy AO, White H, Levelt E, Dall’Armellina E, Gard P, Witte KK, Greenwood JP, Plein S, Swoboda PS. Detrimental immediate and medium-term clinical effects of right ventricular pacing in patients with myocardial fibrosis. Circ: CV Imaging 2021;14:e012256

Whitehead A, Krause FN, Moran A, MacCannell ADV, Scragg JL, McNally BD, Boateng E, Murfitt SA, Virtue S, Wright J, Garnham JO, Davies GR, Dodgson J, Schneider JE, Murray AJ, Church C, Vidal-Puig A, Witte KK, Griffin JL, Roberts LD. Brown and beige adipose tissue regulate systemic metabolism through a metabolite interorgan signaling axis. Nat Comms 2021;12:1905. doi: 10.1038/s41467-021-22272-3.

Straw S, McGinlay M, Drozd M, Slater TA, Cowley A, Kamalathasan S, Maxwell N, Bird R, Koshy AO, Prica M, Patel PA, Relton SD, Gierula J, Cubbon RM, Kearney MT, Witte KK. Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data. BMC Palliat Care 2021;20:10

Drozd M, Pujades-Rodriguez M, Lillie PJ, Straw S, Morgan AW, Kearney MT, Witte KK, Cubbon RM. Non-communicable disease, socio-demographic factors and the risk of infection death: a UK Biobank observational cohort study. Lancet Infectious Dis 2021;20:S1473-3099

Sawyer LS, Witte KK, Reynolds MR, Mittal S, Grimsey Jones FW, Rosemas SC, Ziegler PD, Kaplon RE, Yaghi S. Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke. J Comp Eff Res 2021;10:127-141

Klompstra L, Kyriakou M, Lambrinou E, Piepoli MF, Coats AJS, Cohen-Solal A, Cornelis J, Gellen B, Marques-Sule E, Niederseer D, Orso F, Piotrowicz E, Van Craenenbroeck EM, Simonenko M, Witte KK, Wozniak A, Volterrani M, Jaarsma T. Measuring physical activity with activity monitors in patients with heart failure. From literature to practice. A position paper from the Committee on Exercise Physiology and Training of the HFA of the ESC. Eur J Heart Fail 2021;23:83-91

Drozd M, Relton SD, Walker AMN, Slater T, Gierula J, Paton MF, Lowry JE, Straw S, Koshy AO, Simms AD, Gatenby VK, Sapsford RJ, Witte KK, Kearney MT, Cubbon RM. Association of chronic heart failure and its comorbidities with loss of life expectancy. Heart 2021;107:1417-1421

Caspi T, Straw S, Cheng C, Garnham JO, Scragg JL, Smith J, Koshy AO, Levelt E, Sukumar P, Gierula J, Beech DJ, Kearney MT, Cubbon RM, Wheatcroft SB, Witte KK, Roberts LD, Bowen TS. Unique transcriptome signature distinguishes patients with heart failure myopathy. J Am Heart Assoc 2020;9:e017091. doi: 10.1161/JAHA.120.017091. 

Ruf TF, Kreidel F, Tamm AR, Geyer M, Hahad O, Zirbs JC, Schwidtal BL, Beiras-Fernandez A, Witte KK, Münzel T, von Bardeleben RS Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation. ESC Heart Fail 2020;7:1400-1408 [IF 3.9]

Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, Gierula J, Cubbon RM, Kearney MT, Witte KK. Prioritising symptom management in the treatment of chronic heart failure. ESC Heart Failure 2020;7:2193-207[IF 3.9]

Gierula J, Lowry JE, Paton MF, Cole CA, Byrom R, Koshy AA, Chumun H, Kearney LC, Straw S, Bowen TSE, Cubbon RM, Keenan AM, Stocken DD, Kearney MT, Witte KK. Personalised rate-response programming improves exercise tolerance after six months in people with cardiac implantable electronic devices and heart failure: a phase II study. Circulation 2020;141:1693-1703. doi: 10.1161/CIRCULATIONAHA.119.045066

Iqbal H, Straw S, Craven TP, Stirling K, Wheatcroft SB, Witte KK. Direct oral anticoagulants compared to vitamin-K antagonist for the management of left ventricular thrombus. ESC Heart Failure 2020;7:2032-41[IF 3.9]

Garnham JO, Roberts LD, Espino-Gonzalez E, Whitehead A, Swoboda PP, Koshy A, Gierula J, Paton MF, Cubbon RM, Kearney MT, Egginton S, Bowen TES, Witte KK. Chronic heart failure with diabetes mellitus is characterized by a severe skeletal muscle pathology.J Cachexia Sarcopenia Muscle 2020;11:394-404. doi: 10.1002/jcsm.12515

Garnham JO, Roberts LD, Caspi T, Al-Owais MA, Bullock M, Swoboda PP, Koshy A, Gierula J, Paton MF, Cubbon RM, Kearney MT, Bowen TS, Witte KK. Divergent skeletal muscle mitochondrial phenotype between male and female patients with chronic heart failure. J Cachexia Sarcopenia Muscle 2020;11:79-88. doi: 10.1002/jcsm.12488.

Paton M, Landolina M, Billuart J-R, Field D, Sibley J, Witte KK. Projected longevities of cardiac implantable defibrillators a retrospective analysis over the period 2007-2017 and the impact of technological factors in determining longevity. Europace 2020;22:149-55 [IF 4.0]

Witte KK, Lipiecki J, Siminiak T, Meredith IT, Malkin CJ, Goldberg SL, Stark MA, von Bardeleben RS, Cremer PC, Jaber WA, Celermajer DS, Kaye DM, Sievert H. REDUCE FMR: A randomized sham controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC-HF 2019;7:945-55 [IF 8.8]

Normand C, Linde C, Bogale N, Blomstrom-Lundqvist C, Auricchio A, Stellbrink C, Witte KK, Mullens W, Sticherling C, Marinskis G, Sciaraffia E, Papiashvilli G, Iovev S, Dickstein K. CRT-D or CRT-P, what determines the choice? Findings from the ESC CRT survey II. Europace 2019;21:918-927

Straw S, Byrom R, Gierula J, Paton MF, Koshy A, Cubbon R, Drozd M, Kearney M, Witte KK. Predicting one-year mortality in heart failure using the 'Surprise Question': a prospective pilot study. Eur J Heart Fail 2019;21:227-234 (with editorial) [IF 11.6]

Gierula J, Cubbon RM, Paton MF, Byrom R, Lowry JE, Winsor S, McGinley M, Sunley E, Pickles E, Kearney LC, Koshy A, Slater TA, Chumun H, Jamil HA, Bailey K, Barth JH, Kearney MT, Witte KK. Prospective evaluation and long term follow up of patients referred to secondary care based upon natriuretic peptide levels in primary care. Eur Heart J Qual Care Clin Outcomes 2019;5:218-224

Cubbon RM, Lowry JE, Drozd M, Hall M, Gierula J, Paton MF, Byrom R, Kearney LC, Barth JH, Kearney MT, Witte KK. Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure. Eur J Nutr 2019;58:2535-2543 [IF 4.6]

Witte KK, Patel PA, Walker AMN, Schechter CB, Drozd M, Sengupta A, Byrom R, Kearney LC, Sapsford RJ, Kearney MT, Cubbon RM. Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure. Heart 2018;104:993-998 [IF 5.2]

Drozd M, Gierula J, Lowry JE, Paton MF, Joy E, Jamil HA, Cubbon RM, Kearney MT, Cairns DA, Witte KK. Cardiac resynchronization therapy outcomes in patients with chronic heart failure: CRT-P vs. CRT-D. J Cardiovasc Med 2017;18:962-967

Gierula J, Paton MF, Lowry JE, Jamil HA, Byrom R, Drozd M, Garnham J, Cubbon RM, Cairns DA, Kearney MT, Witte KK. Optimised rate-response programming tailored to the force-frequency relationship improves exercise tolerance in patients with chronic heart failure. JACC-HF 2018;6:105-13 [IF 8.8]

Witte KK, Drozd M, Walker AMN, Patel PA, Kearney JC, Chapman S, Sapsford RJ, Gierula J, Paton MF, Lowry JE, Kearney MT, Cubbon RM. Mortality reduction associated with beta-adrenoceptor inhibition in chronic heart failure is greater in patients with diabetes mellitus. Diabetes Care 2018;41:136-42 (with editorial) [IF 16.0]

Morgan JM, Kitt S, Gill J, McComb JM, Ng GA, Raftery J, Roderick P, Seed A, Williams SG, Witte KK, Wright DJ, Harris S, Cowie MR. Remote management of heart failure using implantable electronic devices. Eur Heart J 2017;38:2352-2360 [IF 22.7]

Jamil HA, Gierula J, Paton MF, Byrom R, Lowry JE, Cubbon RM, Cairns DA, Kearney MT, Witte KK. Chronotropic incompetence does not limit exercise capacity in chronic heart failure. J Am Coll Cardiol 2016;67:1885-96 (with editorial)

Witte KK, Byrom R, Gierula J, Paton MF, Jamil HA, Lowry JE, Gillott RG, Barnes SA, Chumun H, Kearney LC, Greenwood JP, Plein S, Law GR, Pavitt S, Barth JH, Cubbon RM, Kearney MT. Effects of vitamin D on cardiac function in patients with chronic heart failure: The VINDICATE Study. J Am Coll Cardiol 2016;67:2593-60 (with editorial)

Walker AM, Patel PA, Rajwani A, Groves D, Denby C, Kearney L, Sapsford RJ, Witte KK, Kearney MT, Cubbon RM. Diabetes mellitus is associated with adverse structural and functional cardiac remodelling in chronic heart failure with reduced ejection fraction. Diab Vasc Dis Res 2016;13:331-40

Cubbon RM, Witte KK, Kearney LC, Gierula J, Byrom R, Paton M, Sengupta A, Patel PA,  Walker A, Cairns DA, Rajwani A, Hall AS, Sapsford RJ, Kearney MT. Performance of 2014 NICE defibrillator implantation guidelines in heart failure risk stratification. Heart 2016;102:

  1. MASTER-AF – Cardiac Dimensions, USA
  2. Heart rate work - Finapress Medical Systems, Netherlands