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Effect of adaptive cardiac resynchronization therapy in heart failure patients with pacemaker dependency

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

An adaptive cardiac resynchronization therapy (aCRT) algorithm allows continuous adjustments of pacing timings of atrioventricular delays by periodic automatic evaluation of electrical conduction. This applies to patients with an atrioventricular block and is effective in cardiac resynchronization therapy (CRT) devices; however, whether this algorithm benefits patients with pacemaker dependency is uncertain.

Methods

This study examined the clinical impact of an aCRT algorithm in patients diagnosed with heart failure with reduced ejection fraction and pacemaker dependency. A total of 359 patients underwent CRT between January 2016 and December 2022. Patients undergoing pacemaker-dependent CRT with the aCRT algorithm function were selected. Sixty-four patients with pacemaker dependency (31 with aCRT algorithm and 33 without) were included. Pacemaker dependency was defined as the absence of spontaneous ventricular activity during the sensing test at VVI 30 bpm or prolonged atrioventricular delay (> 300 ms). The primary endpoint was the composite clinical outcome of all-cause death or hospitalization for heart failure.

Results

No significant differences were observed in baseline characteristics between groups. During a median follow-up of 1,067 days (interquartile range 553–1,776 days), aCRT reduced the risk of composite clinical outcomes in patients with pacemaker dependency (log-rank P = 0.028). In addition, using the aCRT algorithm was an independent predictor of the composite clinical outcomes in the multivariate analysis (hazard ratio 0.34, 95% confidence interval: 0.12–0.94, P = 0.038).

Conclusion

The aCRT algorithm significantly reduced the risk of adverse clinical outcomes in patients with pacemaker dependency. This algorithm may be an important tool for managing such patients.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

Abbreviations

BMI:

body mass index

BNP:

B-type natriuretic peptide

CRT-D/-P:

cardiac resynchronization therapy with defibrillator/pacemaker

eGFR:

estimated glomerular filtration rate (calculated by Chronic Kidney Disease Epidemiology Collaboration formula)

IQR:

inter-quartile range

LVEF:

left ventricular ejection fraction

MRA:

mineralocorticoid receptor antagonist

NSVT:

non-sustained ventricular tachycardia

MRA:

mineralocorticoid receptor antagonist

NYHA:

New York Heart Association

RASI:

renin?angiotensin-system inhibitor

SD:

standard deviation

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Acknowledgements

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No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Osaka, 564-8565, Japan

    Toshihiro Nakamura, Kohei Ishibashi, Nobuhiko Ueda, Satoshi Oka, Yuichiro Miyazaki, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba & Kengo Kusano

  2. Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Satoshi Oka, Yuichiro Miyazaki, Mitsuru Wada & Kengo Kusano

Authors
  1. Toshihiro Nakamura
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  2. Kohei Ishibashi
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  3. Nobuhiko Ueda
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  4. Satoshi Oka
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  8. Tsukasa Kamakura
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  14. Kengo Kusano
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Contributions

All authors have read and approved the manuscript, as well as substantially contributed to the manuscript: Concept/design: Nakamura T, Ishibashi K. Data analysis/interpretation: Nakamura T, Ishibashi K.Drafting article: Nakamura T, Ishibashi K. Approval of article: Kusano K. Data collection: Ueda N, Oka S, Miyazaki Y, Wakamiya A, Nakajima K, Kamakura T, Wada M, Inoue Y, Miyamoto K, Nagase S, Aiba T.

Corresponding author

Correspondence to Kohei Ishibashi.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Research Board of the National Cerebral and Cardiovascular Center, Suita, Japan (M26-150‐13).

Consent to participate

The patients consented to the use of their anonymized clinical data for research purposes by an opt-out method.

Competing interests

Dr. Kengo Kusano, Dr. Nobuhiko Ueda, and Dr. Kohei Ishibashi received remuneration for lectures from Medtronic Japan, Inc. Dr. Satoshi Nagase is affiliated with a department endowed by Japan Medtronic Inc. The other authors had no conflicts of interest to declare.

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Nakamura, T., Ishibashi, K., Ueda, N. et al. Effect of adaptive cardiac resynchronization therapy in heart failure patients with pacemaker dependency. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01776-0

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