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Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy : results of the adaptive CRT trial

Martin, David O; Lemke, Bernd; Birnie, David; Krum, Henry; Lee, Kathy Lai-Fun; Aonuma, Kazutaka; Gasparini, Maurizio; Starling, Randall C; Milasinovic, Goran and Rogers, Tyson, et al. (2012) In Heart Rhythm 9(11). p.14-1807
Abstract

BACKGROUND: In patients with sinus rhythm and normal atrioventricular conduction, pacing only the left ventricle with appropriate atrioventricular delays can result in superior left ventricular and right ventricular function compared with standard biventricular (BiV) pacing.

OBJECTIVE: To evaluate a novel adaptive cardiac resynchronization therapy ((aCRT) algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular or BiV pacing with dynamic optimization of atrioventricular and interventricular delays.

METHODS: Patients (n = 522) indicated for a CRT-defibrillator were randomized to aCRT vs echo-optimized BiV pacing (Echo) in a 2:1 ratio and followed at 1-, 3-, and 6-month... (More)

BACKGROUND: In patients with sinus rhythm and normal atrioventricular conduction, pacing only the left ventricle with appropriate atrioventricular delays can result in superior left ventricular and right ventricular function compared with standard biventricular (BiV) pacing.

OBJECTIVE: To evaluate a novel adaptive cardiac resynchronization therapy ((aCRT) algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular or BiV pacing with dynamic optimization of atrioventricular and interventricular delays.

METHODS: Patients (n = 522) indicated for a CRT-defibrillator were randomized to aCRT vs echo-optimized BiV pacing (Echo) in a 2:1 ratio and followed at 1-, 3-, and 6-month postrandomization.

RESULTS: The study met all 3 noninferiority primary objectives: (1) the percentage of aCRT patients who improved in their clinical composite score at 6 months was at least as high in the aCRT arm as in the Echo arm (73.6% vs 72.5%, with a noninferiority margin of 12%; P = .0007); (2) aCRT and echo-optimized settings resulted in similar cardiac performance, as demonstrated by a high concordance correlation coefficient between aortic velocity time integrals at aCRT and Echo settings at randomization (concordance correlation coefficient = 0.93; 95% confidence interval 0.91-0.94) and at 6-month postrandomization (concordance correlation coefficient = 0.90; 95% confidence interval 0.87-0.92); and (3) aCRT did not result in inappropriate device settings. There were no significant differences between the arms with respect to heart failure events or ventricular arrhythmia episodes. Secondary end points showed similar benefit, and right-ventricular pacing was reduced by 44% in the aCRT arm.

CONCLUSIONS: The aCRT algorithm is safe and at least as effective as BiV pacing with comprehensive echocardiographic optimization.

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@article{a6a35e9e-0f57-48a0-81ac-ae3de94c8ea4,
  abstract     = {<p>BACKGROUND: In patients with sinus rhythm and normal atrioventricular conduction, pacing only the left ventricle with appropriate atrioventricular delays can result in superior left ventricular and right ventricular function compared with standard biventricular (BiV) pacing.</p><p>OBJECTIVE: To evaluate a novel adaptive cardiac resynchronization therapy ((aCRT) algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular or BiV pacing with dynamic optimization of atrioventricular and interventricular delays.</p><p>METHODS: Patients (n = 522) indicated for a CRT-defibrillator were randomized to aCRT vs echo-optimized BiV pacing (Echo) in a 2:1 ratio and followed at 1-, 3-, and 6-month postrandomization.</p><p>RESULTS: The study met all 3 noninferiority primary objectives: (1) the percentage of aCRT patients who improved in their clinical composite score at 6 months was at least as high in the aCRT arm as in the Echo arm (73.6% vs 72.5%, with a noninferiority margin of 12%; P = .0007); (2) aCRT and echo-optimized settings resulted in similar cardiac performance, as demonstrated by a high concordance correlation coefficient between aortic velocity time integrals at aCRT and Echo settings at randomization (concordance correlation coefficient = 0.93; 95% confidence interval 0.91-0.94) and at 6-month postrandomization (concordance correlation coefficient = 0.90; 95% confidence interval 0.87-0.92); and (3) aCRT did not result in inappropriate device settings. There were no significant differences between the arms with respect to heart failure events or ventricular arrhythmia episodes. Secondary end points showed similar benefit, and right-ventricular pacing was reduced by 44% in the aCRT arm.</p><p>CONCLUSIONS: The aCRT algorithm is safe and at least as effective as BiV pacing with comprehensive echocardiographic optimization.</p>},
  author       = {Martin, David O and Lemke, Bernd and Birnie, David and Krum, Henry and Lee, Kathy Lai-Fun and Aonuma, Kazutaka and Gasparini, Maurizio and Starling, Randall C and Milasinovic, Goran and Rogers, Tyson and Sambelashvili, Alex and Gorcsan, John and Houmsse, Mahmoud and ,  and Borgquist, Rasmus},
  issn         = {1547-5271},
  keyword      = {Aged,Algorithms,Arrhythmias, Cardiac,Cardiac Pacing, Artificial,Cardiac Resynchronization Therapy,Defibrillators, Implantable,Double-Blind Method,Echocardiography,Endpoint Determination,Female,Humans,Male,Middle Aged,Pacemaker, Artificial,Prospective Studies,Quality of Life,Survival Rate,Treatment Outcome,Ventricular Dysfunction, Left,Comparative Study,Journal Article,Multicenter Study,Randomized Controlled Trial,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {11},
  pages        = {14--1807},
  publisher    = {Elsevier},
  series       = {Heart Rhythm},
  title        = {Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy : results of the adaptive CRT trial},
  url          = {http://dx.doi.org/10.1016/j.hrthm.2012.07.009},
  volume       = {9},
  year         = {2012},
}