Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device

Figures & data

Figure 1 Summary of aCRT algorithm.

Notes: Reprinted from American Heart Journal, 163(5), Krum H, Lemke B, Birnie D, et al. A novel algorithm for individualized cardiac resynchronization therapy: rationale and design of the adaptive CRT trial, 747–752. Copyright (2012), with permission from Elsevier.⁸
Abbreviations: aCRT, adaptive cardiac resynchronization therapy; AV, atrio-ventricular; LV, left ventricular; BiV, bi-ventricular; VV, interventricular; DDD/R, dual chamber pacemaker with and without rate response.

Figure 2 Summary of aCRT study.

Notes: Reprinted from Heart Rhythm, 9(11), Martin DO, Lemke B, Birnie D, et al. Investigation of a novel algorithm for synchronized left ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial, 1807–1814. Copyright (2012), with permission from Elsevier.¹³
Abbreviation: aCRT, adaptive cardiac resynchronization therapy.

Figure 3 Summary of aortic velocity time integral (AoVTI) at randomization and at 6-months follow-up comparing aCRT to echo-guided optimization.

Notes: Reprinted from Heart Rhythm, 9(11), Martin DO, Lemke B, Birnie D, et al. Investigation of a novel algorithm for synchronized left ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial, 1807–1814. Copyright (2012), with permission from Elsevier.¹³
Abbreviations: aCRT, adaptive cardiac resynchronization therapy; CCC, concordance correlation coefficient.

Table 1 Secondary end points of aCRT study

	aCRT (n=318)		ECHO (n=160)		95% CI	P* (margin)
	n	Mean ± SD	n	Mean ± SD
LVESVi (mL/m^2)
Baseline	291	71.7±28.3	140	74.0±30.9
6-mos post-randomization	268	63.5±31.9	137	64.7±32.7
Paired difference at 6 mos	250	~8.3±23.3	123	~10.5±24.2	2.3 ~(2.8–7.4)	<0.0001 (15)
LVEF (%)
Baseline	291	29.6±9.2	140	30.3±8.4
6-mos post-randomization	268	33.6±10.4	137	32.9±10.1
Paired difference at 6 mos	250	3.9±10.0	123	2.9±9.8	1.0 ~(1.2–3.1)	0.0009 ~(2.5)
NYHA
Baseline	318	3.0±0.2	160	3.0±0.3
6-mos post-randomization	296	2.0±0.8	153	2.2±0.8
Paired difference at 6 mos	296	~1.0±0.8	153	~0.8±0.8	~0.15 (0.3–0.0)	<0.0001 (0.3)
6-min walk (meters)
Baseline	312	276.8±127.5	156	277.7±137.8
6-mos post-randomization	288	325.5±130.4	146	311.4±152.0
Paired difference at 6 mos	284	42.4±103.3	142	29.0±123.0	13.4 ~(8.9–35.7)	0.0002 ~(30)
MLWHF QOL
Baseline	286	48.5±24.1	142	46.3±23.6
6-mos post-randomization	263	28.2±22.0	139	28.4±23.0
Paired difference at 6 mos	261	~19.3±20.7	135	~17.6±23.8	~1.7 ~(6.3–2.8)	0.002 (5.1)

Notes:

* P-value for noninferiority between aCRT and ECHO arms. Reprinted from Heart Rhythm, 9(11), Martin DO, Lemke B, Birnie D, et al. Investigation of a novel algorithm for synchronized leftventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial, 1807–1814. Copyright (2012), with permission from Elsevier.¹³

Abbreviations: aCRT, adaptive cardiac resynchronization therapy; CI, confidence interval; LVEF, left ventricular ejection fraction; LVESVi, LV end-systolic volume index; min, minute; MLWHF, Minnesota Living With Heart Failure; mos, months; NYHA, New York Heart Association; QOL, quality of life; SD, standard deviation; ECHO, echocardiographic optimization.

Figure 4 Percent of patients improved in CCS during 6-month follow-up.

Notes: Reprinted from Singh JP, Abraham WT, Chung ES, et al. Clinical response with adaptive CRT algorithm compared with CRT with echocardiography optimized atrioventricular delay: a retrospective analysis of multicentre trials. Europace. 2013;15(11):1622–1628 by permission of Oxford University Press.¹⁴
Abbreviation: aCRT, adaptive cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; CCS, Clinical composite score.

Figure 5 Time to all-cause death or first heart failure hospitalization over the 12-month follow-up stratified by percent synchronized left ventricular pacing in the aCRT arm.

Notes: Reprinted from Heart Rhythm, 10(9), Birnie D, Lemke B, Aonuma K, et al. Clinical Outcomes with synchronized left ventricular pacing: analysis of the adaptive CRT trial, 1368–1374. Copyright (2013), with permission from Elsevier.¹²
Abbreviations: CI, confidence interval; aCRT, adaptive cardiac resynchronization therapy; HF, heart failure; HR, hazard ratio; %sLVP, synchronized left ventricular pacing as a percentage of total ventricular pacing over the 12-month follow-up.

Figure 6 Time from heart failure hospitalization to all-cause readmission.

Notes: This figure was published in J Am Coll Cardiol HF, 3(7), Starling RC, Krum H, Bril S, et al. Impact of a Novel Adaptive optimization algorithm on 30-day readmissions evidence from the adaptive CRT trial, 565–572. Copyright Elsevier (2015).¹⁵
Abbreviations: aCRT, adaptive cardiac resynchronization therapy; ECHO, echocardiographic optimization; HF, heart failure; CI, confidence interval.

KrumHLemkeBBirnieDA novel algorithm for individualized cardiac resynchronization therapy: rationale and design of the adaptive CRT trialAm Heart J2012163574775222607850

 PubMed Web of Science ®Google Scholar

MartinDOLemkeBBirnieDInvestigation of a novel algorithm for synchronized leftventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trialHeart Rhythm20129111807181422796472

 PubMed Web of Science ®Google Scholar

SinghJPAbrahamWTChungESClinical response with adaptive CRT algorithm compared with CRT with echocardiography optimized atrioventricular delay: a retrospective analysis of multicentre trialsEuropace201315111622162824014804

 PubMed Web of Science ®Google Scholar

BirnieDLemkeBAonumaKClinical Outcomes with synchronized left ventricular pacing: analysis of the adaptive CRT trialHeart Rhythm20131091368137423851059

 PubMed Web of Science ®Google Scholar

StarlingRCKrumHBrilSImpact of a Novel Adaptive optimization algorithm on 30-day readmissions evidence from the adaptive CRT trialJ Am Coll Cardiol HF201537565572

 Google Scholar