5 years ago

A novel algorithm increases the delivery of effective cardiac resynchronization therapy during atrial fibrillation: The CRTee randomized cross-over trial

Cardiac resynchronization therapy (CRT) requires a high % of ventricular pacing (%Vp) to maximize its clinical benefits. Atrial fibrillation (AF) has been shown to reduce %Vp in CRT due to competition with irregular intrinsic atrio-ventricular (AV) conduction. We report the results of a prospective randomized cross-over trial evaluating the amount of effective CRT delivered during AF with a novel algorithm (eCRTAF). Objective To determine whether eCRTAF increases the amount of effective CRT delivered during AF when compared to a currently available rate regularization algorithm. Methods Patients previously implanted with a CRT-D device, with a history of AF and intact AV conduction, received up to 4 weeks of control (Conducted AF Response) and up to 4 weeks of eCRTAF in a randomized sequence. The % effective CRT (eCRT) pacing, which excludes beats without LV capture, %Vp and mean heart rate (HR) were recorded during AF and sinus rhythm. Results The eCRTAF algorithm resulted in a significantly higher %eCRT during AF than Control (87.8±7.8 % vs 80.8±14.3%, p < 0.001) and %Vp during AF than Control (90.0±5.9% vs 83.2±11.9%, p<0.001) with a small but statistically significant increase in mean HR of 2.5 bpm (79.5±9.7 vs 77.0±9.9 bpm, p<0.001). Conclusions In a cohort of CRT patients with a history of AF, eCRTAF significantly increased the %eCRT pacing and %Vp during AF with a small increase in mean HR. This algorithm may represent a novel non-invasive method of significantly increasing effective CRT delivery during AF, potentially improving CRT response.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117312407

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