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- Title
Atrioventricular and ventricular-to-ventricular programming in patients with cardiac resynchronization therapy: results from ALTITUDE.
- Authors
Steinberg, Benjamin; Wehrenberg, Scott; Jackson, Kevin; Hayes, David; Varma, Niraj; Powell, Brian; Day, John; Frazier-Mills, Camille; Stein, Kenneth; Jones, Paul; Piccini, Jonathan; Steinberg, Benjamin A; Jackson, Kevin P; Hayes, David L; Powell, Brian D; Day, John D; Frazier-Mills, Camille G; Stein, Kenneth M; Jones, Paul W; Piccini, Jonathan P
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
ATRIAL fibrillation treatment; CARDIAC pacing; ARRHYTHMIA treatment; HEALTH outcome assessment; ATRIAL fibrillation; ATRIOVENTRICULAR node; MORTALITY; ARRHYTHMIA; PHYSICIANS
- Publication
Journal of Interventional Cardiac Electrophysiology, 2015, Vol 44, Issue 3, p279
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-015-0058-5