New analyses show that AdaptivCRT algorithm reduces AF episodes in patients

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Two real-world analyses featuring the AdaptivCRT algorithm reinforce that its use is linked to a reduction in atrial fibrillation (AF) episodes, as well as tied to higher patient activity levels. The results, involving 408 patients with heart failure and a cardiac resynchronisation therapy (CRT) device at 26 centres in Italy, were unveiled at the European Heart Rhythm Association (EHRA) Scientific Sessions 2018 in Barcelona, Spain.

The first analysis revealed a significant reduction in the incidence of AF episodes of all measured durations (greater than: one hour, six hours, 12 hours, one day and seven days; p=0.017 for episodes lasting longer than six hours) in 210 patients with AdaptivCRT ON compared to 198 patients with conventional CRT.

“Atrial fibrillation is a common comorbidity among patients with heart failure,” said Alessandro Proclemer, of University Hospital Santa Maria della Misericordia, Udine, Italy. “Progression of AF is linked to an increased risk of stroke and death, so it is encouraging to see additional clinical data that again links AdaptivCRT with a reduction in the incidence of AF in these patients.”

The second analysis showed AdaptivCRT was significantly and independently associated with a higher daily activity level for patients with the feature ON compared to those with conventional CRT (AdaptivCRT ON at 3.1 hours vs. AdaptivCRT OFF at 2.6 hours; p=0.010).

“This finding is important since heart failure patients with low activity levels are more likely to be hospitalised, or even die,” said Saverio Iacopino, of Maria Cecilia Hospital in Cotignola, Italy. “We want our patients to be as active as possible, given the seriousness of their heart condition.”

Heart failure is a progressive condition, affecting more than 26 million people worldwide. CRT is an established treatment for some heart failure patients that uses an implantable defibrillator (CRT-D) or pacemaker (CRT-P) to improve the pumping efficiency of the heart.

The AdaptivCRT algorithm – first available on Medtronic CRT-Ds in 2013 and CRT-Ps in 2014 – adjusts the way the implanted device paces the heart according to minute-to-minute evaluations of each patient’s rhythm. Evidence from the randomised clinical trial demonstrated that AdaptivCRT increases CRT response rate, reduces unnecessary right ventricular pacing, and improves clinical outcomes for patients with normal AV conduction.1-4 Additional analyses showed AdaptivCRT reduces patients’ odds of a 30-day heart failure readmission, and reduced their risk of AF.1,5

 

References

  1. Martin D, et al. Clinical outcomes with adaptive cardiac resynchronization therapy: Long-term outcomes of the Adaptive CRT Trial. HFSA Annual Scientific Meeting. September 23, 2013.
  2. Martin D, 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. Heart Rhythm. 2012; 9(11): 1807-1814.
  3. Birnie D, et al. Clinical outcomes with synchronized left-ventricular pacing: analysis of the adaptive CRT trial. Heart Rhythm 2013; 10(9): 1368-1374.
  4. 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.
  5. 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. JACC Heart Fail. July 2015;3(7):565-572.
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