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

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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.

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Funding sources

This analysis was conducted with support from Boston Scientific. Dr. Steinberg was funded by NIH T-32 training grant no. 5T32 HL 7101–38.

Conflict of interest

The following relationships exist related to this presentation: BS reports modest educational support from Medtronic; SW, PJ, and KS are employees of Boston Scientific; KJ reports research grant support from Medtronic; DH served in an advisory capacity of St. Jude Medical, Boston Scientific, Medtronic; speaks at educational venues of St. Jude Medical, Boston Scientific, Medtronic, Biotronik, and Sorin Medical; and is a steering committee member of St. Jude Medical, Medtronic; JD does not report any relevant disclosures; CF-M serves as a consultant to Boston Scientific; BP has received consulting fees from Boston Scientific; NV received research grants and consultancies from Biotronik, Boston Scientific, Medtronic, St. Jude Medical; JP reports receiving grants for clinical research from ARCA biopharma, Boston Scientific, GE Healthcare, Johnson & Johnson, and ResMed as well as consultancies to Janssen Scientific Affairs and Spectranetics.

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Authors and Affiliations

  1. Electrophysiology Section, Duke University Medical Center, PO Box 17969, Durham, NC, 27715, USA

    Benjamin A. Steinberg, Kevin P. Jackson, Camille G. Frazier-Mills & Jonathan P. Piccini

  2. Duke Clinical Research Institute, PO Box 17969, Durham, NC, 27715, USA

    Benjamin A. Steinberg & Jonathan P. Piccini

  3. Boston Scientific, St. Paul, MN, USA

    Scott Wehrenberg, Kenneth M. Stein & Paul W. Jones

  4. Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA

    David L. Hayes

  5. Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    Niraj Varma

  6. Division of Cardiovascular Disease, Sanger Heart & Vascular Institute, Charlotte, NC, USA

    Brian D. Powell

  7. Division of Cardiovascular Disease, Intermountain Medical Center, Salt Lake City, UT, USA

    John D. Day

Authors
  1. Benjamin A. Steinberg
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  2. Scott Wehrenberg
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  7. John D. Day
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  8. Camille G. Frazier-Mills
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  9. Kenneth M. Stein
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  10. Paul W. Jones
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  11. Jonathan P. Piccini
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Corresponding author

Correspondence to Benjamin A. Steinberg.

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Steinberg, B.A., Wehrenberg, S., Jackson, K.P. et al. Atrioventricular and ventricular-to-ventricular programming in patients with cardiac resynchronization therapy: results from ALTITUDE. J Interv Card Electrophysiol 44, 279–287 (2015). https://doi.org/10.1007/s10840-015-0058-5

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  • DOI: https://doi.org/10.1007/s10840-015-0058-5

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