Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: Results of the adaptive CRT trial

David O. Martin; Bernd Lemke; David Birnie; Henry Krum; Kathy Lai Fun Lee; Kazutaka Aonuma; Maurizio Gasparini; Randall C. Starling; Goran Milasinovic; Tyson Rogers; Alex Sambelashvili; John Gorcsan; Mahmoud Houmsse; P. Wells; A. Merliss; I. Khan; J. Stone; D. Rodak; S. Lee; S. Milstein; T. Svinarich; D. Lustgarten; Robert A Sorrentino; J. McKenzie; J. Hobson; J. S. Allison; De Bruyn Van De Bruyn; T. Lessmeier; W. Johnson; S. Goel; M. Emert; R. Lerman; M. Chaudhry; S. Klein; M. Imburgia; M. Gold; L. Zaman; B. Ramza; J. Bailey; D. Bello; B. Foreman; R. Kawasaki; J. Lobban; J. Curwin; G. Turitto; J. Lowy; S. Karanam; E. Putz; J. Collier; J. Simonson; B. Mikaelian; S. Compton; L. Pires; J. Walsh; M. Wadhwa; J. Herre; R. Canby; K. Bruce; J. Sims; R. Carney; A. Bank; M. Borganelli; W. Clair; R. Shepard; J. Cheung; D. Elmouchi; F. Heath; A. Kypta; P. T. Mortensen; F. Voss; T. Lawo; L. H. Bouwels; M. E. Landolina; S. Faerestrand; M. Gil; D. V. Kovacevic; J. Hörnsten; Z. Perisic; H. Nägele; M. Scheffer; A. Brandes; E. Kongsgård; C. Hassager; A. Hersi; V. A. Kuznetsov; M. A. Aydin; R. Borgquist; W. Mullens; V. Paul; M. Kilborn; J. Hayes; B. Walker; R. Denman; P. Sanders; R. Yee; Y. Khaykin; G. Sumner; A. Tang; S. Kamakura; H. F. Tse

doi:10.1016/j.hrthm.2012.07.009

Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: Results of the adaptive CRT trial

David O. Martin, Bernd Lemke, David Birnie, Henry Krum, Kathy Lai Fun Lee, Kazutaka Aonuma, Maurizio Gasparini, Randall C. Starling, Goran Milasinovic, Tyson Rogers, Alex Sambelashvili, John Gorcsan, Mahmoud Houmsse, P. Wells, A. Merliss, I. Khan, J. Stone, D. Rodak, S. Lee, S. MilsteinT. Svinarich, D. Lustgarten, Robert A Sorrentino, J. McKenzie, J. Hobson, J. S. Allison, De Bruyn Van De Bruyn, T. Lessmeier, W. Johnson, S. Goel, M. Emert, R. Lerman, M. Chaudhry, S. Klein, M. Imburgia, M. Gold, L. Zaman, B. Ramza, J. Bailey, D. Bello, B. Foreman, R. Kawasaki, J. Lobban, J. Curwin, G. Turitto, J. Lowy, S. Karanam, E. Putz, J. Collier, J. Simonson, B. Mikaelian, S. Compton, L. Pires, J. Walsh, M. Wadhwa, J. Herre, R. Canby, K. Bruce, J. Sims, R. Carney, A. Bank, M. Borganelli, W. Clair, R. Shepard, J. Cheung, D. Elmouchi, F. Heath, A. Kypta, P. T. Mortensen, F. Voss, T. Lawo, L. H. Bouwels, M. E. Landolina, S. Faerestrand, M. Gil, D. V. Kovacevic, J. Hörnsten, Z. Perisic, H. Nägele, M. Scheffer, A. Brandes, E. Kongsgård, C. Hassager, A. Hersi, V. A. Kuznetsov, M. A. Aydin, R. Borgquist, W. Mullens, V. Paul, M. Kilborn, J. Hayes, B. Walker, R. Denman, P. Sanders, R. Yee, Y. Khaykin, G. Sumner, A. Tang, S. Kamakura, H. F. Tse

Cardiology

Research output: Contribution to journal › Article › peer-review

209 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1807-1814.e1
Journal	Heart Rhythm
Volume	9
Issue number	11
DOIs	https://doi.org/10.1016/j.hrthm.2012.07.009
State	Published - Nov 1 2012

Keywords

Cardiac resynchronization therapy
Fusion pacing
Heart failure
LV pacing
Optimization

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1016/j.hrthm.2012.07.009

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Martin, D. O., Lemke, B., Birnie, D., Krum, H., Lee, K. L. F., Aonuma, K., Gasparini, M., Starling, R. C., Milasinovic, G., Rogers, T., Sambelashvili, A., Gorcsan, J., Houmsse, M., Wells, P., Merliss, A., Khan, I., Stone, J., Rodak, D., Lee, S., ... Tse, H. F. (2012). 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, 9(11), 1807-1814.e1. https://doi.org/10.1016/j.hrthm.2012.07.009

Martin, DO, Lemke, B, Birnie, D, Krum, H, Lee, KLF, Aonuma, K, Gasparini, M, Starling, RC, Milasinovic, G, Rogers, T, Sambelashvili, A, Gorcsan, J, Houmsse, M, Wells, P, Merliss, A, Khan, I, Stone, J, Rodak, D, Lee, S, Milstein, S, Svinarich, T, Lustgarten, D, Sorrentino, RA, McKenzie, J, Hobson, J, Allison, JS, Van De Bruyn, DB, Lessmeier, T, Johnson, W, Goel, S, Emert, M, Lerman, R, Chaudhry, M, Klein, S, Imburgia, M, Gold, M, Zaman, L, Ramza, B, Bailey, J, Bello, D, Foreman, B, Kawasaki, R, Lobban, J, Curwin, J, Turitto, G, Lowy, J, Karanam, S, Putz, E, Collier, J, Simonson, J, Mikaelian, B, Compton, S, Pires, L, Walsh, J, Wadhwa, M, Herre, J, Canby, R, Bruce, K, Sims, J, Carney, R, Bank, A, Borganelli, M, Clair, W, Shepard, R, Cheung, J, Elmouchi, D, Heath, F, Kypta, A, Mortensen, PT, Voss, F, Lawo, T, Bouwels, LH, Landolina, ME, Faerestrand, S, Gil, M, Kovacevic, DV, Hörnsten, J, Perisic, Z, Nägele, H, Scheffer, M, Brandes, A, Kongsgård, E, Hassager, C, Hersi, A, Kuznetsov, VA, Aydin, MA, Borgquist, R, Mullens, W, Paul, V, Kilborn, M, Hayes, J, Walker, B, Denman, R, Sanders, P, Yee, R, Khaykin, Y, Sumner, G, Tang, A, Kamakura, S & Tse, HF 2012, '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, vol. 9, no. 11, pp. 1807-1814.e1. https://doi.org/10.1016/j.hrthm.2012.07.009

@article{15a09e9a6145425192cd108635b96d0f,

title = "Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: Results of the adaptive CRT trial",

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.",

keywords = "Cardiac resynchronization therapy, Fusion pacing, Heart failure, LV pacing, Optimization",

author = "Martin, {David O.} and Bernd Lemke and David Birnie and Henry Krum and Lee, {Kathy Lai Fun} and Kazutaka Aonuma and Maurizio Gasparini and Starling, {Randall C.} and Goran Milasinovic and Tyson Rogers and Alex Sambelashvili and John Gorcsan and Mahmoud Houmsse and P. Wells and A. Merliss and I. Khan and J. Stone and D. Rodak and S. Lee and S. Milstein and T. Svinarich and D. Lustgarten and Sorrentino, {Robert A} and J. McKenzie and J. Hobson and Allison, {J. S.} and {Van De Bruyn}, {De Bruyn} and T. Lessmeier and W. Johnson and S. Goel and M. Emert and R. Lerman and M. Chaudhry and S. Klein and M. Imburgia and M. Gold and L. Zaman and B. Ramza and J. Bailey and D. Bello and B. Foreman and R. Kawasaki and J. Lobban and J. Curwin and G. Turitto and J. Lowy and S. Karanam and E. Putz and J. Collier and J. Simonson and B. Mikaelian and S. Compton and L. Pires and J. Walsh and M. Wadhwa and J. Herre and R. Canby and K. Bruce and J. Sims and R. Carney and A. Bank and M. Borganelli and W. Clair and R. Shepard and J. Cheung and D. Elmouchi and F. Heath and A. Kypta and Mortensen, {P. T.} and F. Voss and T. Lawo and Bouwels, {L. H.} and Landolina, {M. E.} and S. Faerestrand and M. Gil and Kovacevic, {D. V.} and J. H{\"o}rnsten and Z. Perisic and H. N{\"a}gele and M. Scheffer and A. Brandes and E. Kongsg{\aa}rd and C. Hassager and A. Hersi and Kuznetsov, {V. A.} and Aydin, {M. A.} and R. Borgquist and W. Mullens and V. Paul and M. Kilborn and J. Hayes and B. Walker and R. Denman and P. Sanders and R. Yee and Y. Khaykin and G. Sumner and A. Tang and S. Kamakura and Tse, {H. F.}",

note = "Funding Information: The trial was sponsored by Medtronic, Mounds View, Minnesota. Dr Martin serves on a Medtronic advisory board. Dr Lemke has received honoraria and speaker's fees from Medtronic and Saint Jude Medical and speaker's fees from Boston Scientific. Dr Birnie has received honoraria and research grants from Medtronic . Dr Krum has received honoraria from Medtronic. Dr Lee has received research grants from Medtronic . Dr Aonuma has received honoraria, speaker's fees, and research grants from Medtronic . Dr Gasparini has received honoraria and served on advisory boards for Medtronic and Boston Scientific. Dr Starling has received honoraria from Novartis. Dr Milasinovic has received honoraria from Medtronic. Dr Gorcsan has consulted for or has received research grants from Biotronik , Medtronic , St Jude Medical , GE , and Toshiba Medical . T. Rogers is a statistician employed by Medtronic. A. Sambelashvili is a scientist employed by Medtronic. ",

year = "2012",

month = nov,

day = "1",

doi = "10.1016/j.hrthm.2012.07.009",

language = "English (US)",

volume = "9",

pages = "1807--1814.e1",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

number = "11",

}

TY - JOUR

T1 - Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy

T2 - Results of the adaptive CRT trial

AU - Martin, David O.

AU - Lemke, Bernd

AU - Birnie, David

AU - Krum, Henry

AU - Lee, Kathy Lai Fun

AU - Aonuma, Kazutaka

AU - Gasparini, Maurizio

AU - Starling, Randall C.

AU - Milasinovic, Goran

AU - Rogers, Tyson

AU - Sambelashvili, Alex

AU - Gorcsan, John

AU - Houmsse, Mahmoud

AU - Wells, P.

AU - Merliss, A.

AU - Khan, I.

AU - Stone, J.

AU - Rodak, D.

AU - Lee, S.

AU - Milstein, S.

AU - Svinarich, T.

AU - Lustgarten, D.

AU - Sorrentino, Robert A

AU - McKenzie, J.

AU - Hobson, J.

AU - Allison, J. S.

AU - Van De Bruyn, De Bruyn

AU - Lessmeier, T.

AU - Johnson, W.

AU - Goel, S.

AU - Emert, M.

AU - Lerman, R.

AU - Chaudhry, M.

AU - Klein, S.

AU - Imburgia, M.

AU - Gold, M.

AU - Zaman, L.

AU - Ramza, B.

AU - Bailey, J.

AU - Bello, D.

AU - Foreman, B.

AU - Kawasaki, R.

AU - Lobban, J.

AU - Curwin, J.

AU - Turitto, G.

AU - Lowy, J.

AU - Karanam, S.

AU - Putz, E.

AU - Collier, J.

AU - Simonson, J.

AU - Mikaelian, B.

AU - Compton, S.

AU - Pires, L.

AU - Walsh, J.

AU - Wadhwa, M.

AU - Herre, J.

AU - Canby, R.

AU - Bruce, K.

AU - Sims, J.

AU - Carney, R.

AU - Bank, A.

AU - Borganelli, M.

AU - Clair, W.

AU - Shepard, R.

AU - Cheung, J.

AU - Elmouchi, D.

AU - Heath, F.

AU - Kypta, A.

AU - Mortensen, P. T.

AU - Voss, F.

AU - Lawo, T.

AU - Bouwels, L. H.

AU - Landolina, M. E.

AU - Faerestrand, S.

AU - Gil, M.

AU - Kovacevic, D. V.

AU - Hörnsten, J.

AU - Perisic, Z.

AU - Nägele, H.

AU - Scheffer, M.

AU - Brandes, A.

AU - Kongsgård, E.

AU - Hassager, C.

AU - Hersi, A.

AU - Kuznetsov, V. A.

AU - Aydin, M. A.

AU - Borgquist, R.

AU - Mullens, W.

AU - Paul, V.

AU - Kilborn, M.

AU - Hayes, J.

AU - Walker, B.

AU - Denman, R.

AU - Sanders, P.

AU - Yee, R.

AU - Khaykin, Y.

AU - Sumner, G.

AU - Tang, A.

AU - Kamakura, S.

AU - Tse, H. F.

N1 - Funding Information: The trial was sponsored by Medtronic, Mounds View, Minnesota. Dr Martin serves on a Medtronic advisory board. Dr Lemke has received honoraria and speaker's fees from Medtronic and Saint Jude Medical and speaker's fees from Boston Scientific. Dr Birnie has received honoraria and research grants from Medtronic . Dr Krum has received honoraria from Medtronic. Dr Lee has received research grants from Medtronic . Dr Aonuma has received honoraria, speaker's fees, and research grants from Medtronic . Dr Gasparini has received honoraria and served on advisory boards for Medtronic and Boston Scientific. Dr Starling has received honoraria from Novartis. Dr Milasinovic has received honoraria from Medtronic. Dr Gorcsan has consulted for or has received research grants from Biotronik , Medtronic , St Jude Medical , GE , and Toshiba Medical . T. Rogers is a statistician employed by Medtronic. A. Sambelashvili is a scientist employed by Medtronic.

PY - 2012/11/1

Y1 - 2012/11/1

N2 - 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.

AB - 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.

KW - Cardiac resynchronization therapy

KW - Fusion pacing

KW - Heart failure

KW - LV pacing

KW - Optimization

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ER -

Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: Results of the adaptive CRT trial

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