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THE IMPACT OF PACING ALGORITHMS ON DELIVERY OF BIVENTRICULAR PACING: ANALYSIS OF DEVICE DATA FROM 76,955 CRT PATIENTS
E671 JACC March 12, 2013 Volume 61, Issue 10
Heart Failure The Impact of Pacing Algorithms on Delivery of Bi-Ventricular Pacing: Analysis of Device Data from 76,955 CRT Patients Moderated Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Insights into Cardiac Resynchronization and Device Therapies in Heart Failure Abstract Category: 15. Heart Failure: Clinical Presentation Number: 1219M-268 Authors: Aleksandre Sambelashvili, Vadim Levin, James Johnson, Medtronic Inc., Mounds View, MN, USA, Lehigh Valley Hospital, Allentown, PA, USA Background: Lower percentage of bi-ventricularly paced beats (%VP) is associated with a higher mortality in Cardiac Resynchronization Therapy (CRT) patients. Modern CRT devices provide algorithms to increase %VP, such as Ventricular Sense Response (VSR), Conducted Atrial Fibrillation Response (CAFR) and Atrial Tracking Recovery (ATR). We aimed to determine if utilization of these three algorithms was associated with increased %VP. Methods: We analyzed device diagnostics transmitted from 76,955 CRT-D recipients into the CareLink (Medtronic Inc.) database between 2005 and 2012. Patients in whom CRT pacing was intentionally programmed OFF were excluded. Mean %VP over the device life-time and proportion of patients with %VP <90% were compared between patients with the algorithms programmed ON vs. OFF. The comparison was also done by Atrial Fibrillation (AF) burden, determined from the device diagnostics. Results: Patients with the algorithms ON had higher %VP than those who had all algorithms OFF (Table). Proportion of patients with %VP<90% was 9.9% and 18.3% (p<0.001) with the algorithms ON and OFF respectively. The difference in %VP was observed mainly in patients with No/Little or Paroxysmal AF and was primarily due to the operation CAFR and VSR algorithms. Conclusions: Utilizing CRT pacing algorithms was associated with an increase in %VP and reduction in the proportion of patients with %VP<90% for patients with No/Little or Paroxysmal AF. Comparison of %VP between patients with CRT pacing algorithms programmed ON and OFF. Algorithms ON Patient group (Mean ± SD All 96.1 patients with or w/o AF ± 6.0 No/Little 97.0 AF ± 4.9 Paroxysmal 96.4 AF ± 4.9 Persistent 92.9 AF ± 7.9 89.3 Permanent AF ± 10.2
Algorithms OFF (Mean ± SD) 93.2 ± 11.5 93.7 ± 11.4 93.0 ± 12.0 91.8 ± 11.4 92.8 ± 10.5
p-value (t-test) < 0.001 < 0.001 < 0.001 0.070 0.041
Heart Failure The Impact of Pacing Algorithms on Delivery of Bi-Ventricular Pacing: Analysis of Device Data from 76,955 CRT Patients Moderated Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Insights into Cardiac Resynchronization and Device Therapies in Heart Failure Abstract Category: 15. Heart Failure: Clinical Presentation Number: 1219M-268 Authors: Aleksandre Sambelashvili, Vadim Levin, James Johnson, Medtronic Inc., Mounds View, MN, USA, Lehigh Valley Hospital, Allentown, PA, USA Background: Lower percentage of bi-ventricularly paced beats (%VP) is associated with a higher mortality in Cardiac Resynchronization Therapy (CRT) patients. Modern CRT devices provide algorithms to increase %VP, such as Ventricular Sense Response (VSR), Conducted Atrial Fibrillation Response (CAFR) and Atrial Tracking Recovery (ATR). We aimed to determine if utilization of these three algorithms was associated with increased %VP. Methods: We analyzed device diagnostics transmitted from 76,955 CRT-D recipients into the CareLink (Medtronic Inc.) database between 2005 and 2012. Patients in whom CRT pacing was intentionally programmed OFF were excluded. Mean %VP over the device life-time and proportion of patients with %VP <90% were compared between patients with the algorithms programmed ON vs. OFF. The comparison was also done by Atrial Fibrillation (AF) burden, determined from the device diagnostics. Results: Patients with the algorithms ON had higher %VP than those who had all algorithms OFF (Table). Proportion of patients with %VP<90% was 9.9% and 18.3% (p<0.001) with the algorithms ON and OFF respectively. The difference in %VP was observed mainly in patients with No/Little or Paroxysmal AF and was primarily due to the operation CAFR and VSR algorithms. Conclusions: Utilizing CRT pacing algorithms was associated with an increase in %VP and reduction in the proportion of patients with %VP<90% for patients with No/Little or Paroxysmal AF. Comparison of %VP between patients with CRT pacing algorithms programmed ON and OFF. Algorithms ON Patient group (Mean ± SD All 96.1 patients with or w/o AF ± 6.0 No/Little 97.0 AF ± 4.9 Paroxysmal 96.4 AF ± 4.9 Persistent 92.9 AF ± 7.9 89.3 Permanent AF ± 10.2
Algorithms OFF (Mean ± SD) 93.2 ± 11.5 93.7 ± 11.4 93.0 ± 12.0 91.8 ± 11.4 92.8 ± 10.5
p-value (t-test) < 0.001 < 0.001 < 0.001 0.070 0.041