Clinical outcomes with synchronized left ventricular pacing: Analysis of the adaptive CRT trial

David Birnie, Bernd Lemke, Kazutaka Aonuma, Henry Krum, Kathy Lai Fun Lee, Maurizio Gasparini, Randall C. Starling, Goran Milasinovic, John Gorcsan, Mahmoud Houmsse, Athula Abeyratne, Alex Sambelashvili, David O. Martin

Research output: Contribution to journalArticlepeer-review

Abstract

Background Acute studies have suggested that left ventricular pacing (LVP) may have benefits over biventricular pacing (BVP). The adaptive cardiac resynchronization therapy (aCRT) algorithm provides LVP synchronized to produce fusion with the intrinsic activation when the intrinsic atrioventricular (AV) interval is normal. The randomized double-blind adaptive cardiac resynchronization therapy trial demonstrated noninferiority of the aCRT algorithm compared to echocardiography-optimized BVP (control). Objective To examine whether synchronized LVP (sLVP) resulted in better clinical outcomes. Methods First, stratification by percent sLVP (%sLVP) and multivariate Cox proportional hazards model was used to assess the relationship between %sLVP and clinical outcomes. Second, outcomes were compared between patients in the aCRT arm (n = 318) and control patients (n = 160) stratified by intrinsic AV interval at randomization. Results In the aCRT arm, %sLVP ≥50% (n = 142) was independently associated with a decreased risk of death or heart failure hospitalization (hazard ratio 0.49; 95% confidence interval 0.28-0.85; P =.012) compared with %sLVP <50% (n = 172). A greater proportion of patients with %sLVP ≥50% improved in Packer's clinical composite score at 6-month (82% vs 68%; P =.002) and 12-month (80% vs 62%; P =.0006) follow-ups compared to controls. In the subgroup with normal AV (n = 241), there was a lower risk of death or heart failure hospitalization (hazard ratio 0.52; 95% confidence interval 0.27-0.98; P =.044) with the aCRT algorithm. A greater proportion of patients in the aCRT arm improved in the clinical composite score at 6-month (81% vs 69%; P =.041) and 12-month (77% vs 66%; P =.076) follow-ups compared to controls. Conclusions Higher %sLVP was independently associated with superior clinical outcomes. In patients with normal AV conduction, the aCRT algorithm provided mostly sLVP and demonstrated better clinical outcomes compared to echocardiography-optimized BVP.

Original languageEnglish (US)
Pages (from-to)1368-1374
Number of pages7
JournalHeart Rhythm
Volume10
Issue number9
DOIs
StatePublished - Sep 2013

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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