Atrioventricular and ventricular-to-ventricular programming in patients with cardiac resynchronization therapy: results from ALTITUDE.

Abstract

PURPOSE:

Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure, yet response rates are variable. We sought to determine whether physician-specified CRT programming was associated with improved outcomes.

METHODS:

Using data from the ALTITUDE remote follow-up cohort, we examined sensed atrioventricular (AV) and ventricular-to-ventricular (VV) programming and their associated outcomes in patients with de novo CRT from 2009-2010. Outcomes included arrhythmia burden, left ventricular (LV) pacing, and all-cause mortality at 4 years.

RESULTS:

We identified 5709 patients with de novo CRT devices; at the time of implant, 34% (n = 1959) had entirely nominal settings programmed, 40% (n = 2294) had only AV timing adjusted, 11% (n = 604) had only VV timing adjusted, and 15% (n = 852) had both AV and VV adjusted from nominal programming. Suboptimal LV pacing (<95%) during follow-up was similar across groups; however, the proportion with atrial fibrillation (AF) burden >5% was lowest in the AV-only adjusted group (17.9%) and highest in the nominal (27.7%) and VV-only adjusted (28.3%) groups. Adjusted all-cause mortality was significantly higher among patients with non-nominal AV delay >120 vs. <120 ms (adjusted heart rate (HR) 1.28, p = 0.008) but similar when using the 180-ms cutoff (adjusted HR 1.13 for >180 vs. ≤180 ms, p = 0.4).

CONCLUSIONS:

Nominal settings for de novo CRT implants are frequently altered, most commonly the AV delay. There is wide variability in reprogramming. Patients with nominal or AV-only adjustments appear to have favorable pacing and arrhythmia outcomes. Sensed AV delays less than 120 ms are associated with improved survival.

• Authors: Benjamin A Steinberg, Scott Wehrenberg, Kevin P Jackson, David L Hayes, Niraj Varma, Brian D Powell, John D Day, Camille G Frazier-Mills, Kenneth M Stein, Paul W Jones, Jonathan P Piccini
• Journal: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (J Interv Card Electrophysiol) Vol. 44 Issue 3 Pg. 279-87 (Dec 2015) ISSN: 1572-8595 [Electronic] Netherlands
• PMID: 26400764 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Aged
• Arrhythmias, Cardiac (mortality, prevention & control)
• Cardiac Resynchronization Therapy (mortality)
• Comorbidity
• Diagnosis, Computer-Assisted (methods, mortality)
• Female
• Heart Failure (mortality, prevention & control)
• Heart Rate
• Humans
• Incidence
• Male
• Prevalence
• Reproducibility of Results
• Retrospective Studies
• Risk Factors
• Sensitivity and Specificity
• Survival Rate
• Therapy, Computer-Assisted (methods, statistics & numerical data)
• Treatment Outcome
• United States