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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/14973

Title: Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial
Authors: Martin, David O.
Lemke, Bernd
Birnie, David
Krum, Henry
Lai-Fun Lee, Kathy
Aonuma, Kazutaka
Gasparini, Maurizio
Starling, Randall C.
Milasinovic, Goran
Rogers, Tyson
Sambelashvili, Alex
Gorcsan, John
Houmsse, Mahmoud
Mullens, W.
CRT Study Investigators
Issue Date: 2012
Citation: HEART RHYTHM, 9 (11), p. 1807-1814
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 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.
URI: http://hdl.handle.net/1942/14973
DOI: 10.1016/j.hrthm.2012.07.009
ISI #: 000310532300015
ISSN: 1547-5271
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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