Hiro Yamasaki1, Daniel Lustgarten2, Jeffrey Cerkvenik3, David Birnie4, Maurizio Gasparini5, Kathy Lia-Fun Lee6, Yukio Sekiguchi7, Niraj Varma8, Bernd Lemke9, Randall C Starling8, Kazutaka Aonuma7. 1. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: hyamasaki@md.tsukuba.ac.jp. 2. The University of Vermont Medical Center, Burlington, Vermont, United States. 3. Medtronic, plc, Mounds View, MN, United States. 4. University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 5. Istituto Clinico Humanitas Mirasole, Rozzano, Italy. 6. Queen Mary Hospital, The University of Hong Kong, Hong Kong. 7. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 8. The Cleveland Clinic, Cleveland, OH, United States. 9. Department of Cardiology, Hospital Lüdenscheid, Lüdenscheid, Germany.
Abstract
BACKGROUND:Adaptive cardiac resynchronization therapy (aCRT) is a dynamic optimization algorithm which paces only the left ventricle (LV) when atrio-ventricular (AV) conduction is normal, thus reducing right ventricular (RV) pacing. However, the impact of QRS duration on aCRTefficacy remains uncertain. We examined whether QRS duration impacts aCRT effectiveness in patients with left bundle branch block (LBBB) and preserved AV conduction. METHODS: Randomized patients in the Adaptive CRT trial, which enrolled NYHA III/IV patients, were used in this analysis. Patients were randomized to receive aCRT or echo-optimized bi-ventricular CRT (control arm). Endpoints for this analysis were clinical composite score (CCS) at 6months post-implant and time to first heart failure (HF) hospitalization or death. RESULTS: Among the 199 patients with LBBB and normal AV intervals at baseline, 80 patients (40%) had a baseline moderately wide QRS of 120-150ms. In this subgroup, a greater proportion of aCRT patients had an improved CCS (79% vs. 50%) at 6months compared to the control group (p=0.03). There was also a trend toward a lower risk of death or HF hospitalization (hazard ratio: 0.53; 95% CI: 0.24-1.15; p=0.10) in the moderately wide QRS subgroup with aCRT compared to the control arm. In the wide QRS subgroup, the efficacy was comparable in both treatment arms. CONCLUSION:Adaptive CRT was associated with improved patient outcomes over echo-optimized bi-ventricular CRT in patients with preserved AV conduction, LBBB, and moderately wide QRS. The adaptive cardiac resynchronization therapy trial (ClinicalTrials.gov Identifier: NCT00980057) was sponsored by Medtronic plc, Mounds View, MN.
RCT Entities:
BACKGROUND: Adaptive cardiac resynchronization therapy (aCRT) is a dynamic optimization algorithm which paces only the left ventricle (LV) when atrio-ventricular (AV) conduction is normal, thus reducing right ventricular (RV) pacing. However, the impact of QRS duration on aCRT efficacy remains uncertain. We examined whether QRS duration impacts aCRT effectiveness in patients with left bundle branch block (LBBB) and preserved AV conduction. METHODS: Randomized patients in the Adaptive CRT trial, which enrolled NYHA III/IV patients, were used in this analysis. Patients were randomized to receive aCRT or echo-optimized bi-ventricular CRT (control arm). Endpoints for this analysis were clinical composite score (CCS) at 6months post-implant and time to first heart failure (HF) hospitalization or death. RESULTS: Among the 199 patients with LBBB and normal AV intervals at baseline, 80 patients (40%) had a baseline moderately wide QRS of 120-150ms. In this subgroup, a greater proportion of aCRT patients had an improved CCS (79% vs. 50%) at 6months compared to the control group (p=0.03). There was also a trend toward a lower risk of death or HF hospitalization (hazard ratio: 0.53; 95% CI: 0.24-1.15; p=0.10) in the moderately wide QRS subgroup with aCRT compared to the control arm. In the wide QRS subgroup, the efficacy was comparable in both treatment arms. CONCLUSION: Adaptive CRT was associated with improved patient outcomes over echo-optimized bi-ventricular CRT in patients with preserved AV conduction, LBBB, and moderately wide QRS. The adaptive cardiac resynchronization therapy trial (ClinicalTrials.gov Identifier: NCT00980057) was sponsored by Medtronic plc, Mounds View, MN.
Authors: Niraj Varma; David O'Donnell; Mohammed Bassiouny; Philippe Ritter; Carlo Pappone; Jan Mangual; Daniel Cantillon; Nima Badie; Bernard Thibault; Brian Wisnoskey Journal: J Am Heart Assoc Date: 2018-02-06 Impact factor: 5.501