Continuous optimization of cardiac resynchronization therapy reduces atrial fibrillation in heart failure patients: Results of the Adaptive Cardiac Resynchronization Therapy Trial
Continuous optimization of cardiac resynchronization therapy reduces atrial fibrillation in heart failure patients: Results of the Adaptive Cardiac Resynchronization Therapy Trial
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DOI：
10.1016/j.hrthm.2017.08.017
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发表时间：
2017-12-01
期刊：
影响因子：
5.5
通讯作者：
Martin, David O.
中科院分区：
文献类型：
--
作者：
Birnie, David;Hudnall, Harrison;Martin, David O.
随机试验的数据表明，常规心脏起搏治疗（convCRT）对房颤（AF）的发生率影响不大或没有影响。AdaptivCRT（aCRT，Medtronic，土丘View，MN）是一种用于同步左心室（LV）起搏和持续优化心脏起搏治疗（CRT）的新方法。目的比较aCRT和convCRT起搏对AF发生率的长期影响。aCRT算法每分钟评估一次固有传导，在正常房室（AV）传导期间提供仅LV起搏，在延长AV传导期间提供AV和心室定时调整。该亚组分析的主要结果是通过设备诊断检测到的AF > 48小时连续发作。结果在平均和标准差为20.2 +/- 5.9个月的随访期间，8.7%的aCRT患者和16.2%的convCRT患者经历了主要结果（风险比[HR] = 0.54; 95%置信区间[CI] = 0.31-0.93; P= 0.03）。在基线AV延长的患者中，随机分配至aCRT的患者的主要结局发生率为12.8%，而convCRT患者为27.4%（HR = 0.45; 95% CI = 0.24-0.85; P= 0.01）。此外，aCRT组房颤发作被判定为临床不良事件的患者比例（4.3%）低于convCRT组（12.7%）（HR = 0.39; 95% CI = 0.19-0.79; P= 0.01）。大多数AF减少发生在基线时AV传导延长和显著左心房逆向重构的亚组中。
BACKGROUND Data from randomized trials have suggested a modest or no effect of conventional cardiac resynchronization therapy (convCRT) on the incidence of atrial fibrillation (AF). AdaptivCRT (aCRT, Medtronic, Mounds View, MN) is a recently described algorithm for synchronized left ventricular (LV) pacing and continuous optimization of cardiac resynchronization therapy (CRT).OBJECTIVE We compared the long-term effects of aCRT with convCRT pacing on the incidence of AF.METHODS The Adaptive CRT trial randomized CRT-defibrillator (CRT-D)-indicated patients (2:1) to receive either aCRT or convCRT pacing. The aCRT algorithm evaluates intrinsic conduction every minute, providing LV-only pacing during normal atrioventricular (AV) conduction and AV and ventriculoventricular timing adjustments during prolonged AV conduction. The primary outcome of this subanalysis was an episode of AF > 48 consecutive hours as detected by device diagnostics.RESULTS Over a follow-up period with a mean and standard deviation of 20.2 +/- 5.9 months, 8.7% of patients with aCRT and 16.2% with convCRT experienced the primary outcome (hazard ratio [HR] = 0.54; 95% confidence interval [CI] = 0.31-0.93; P=.03). In patients with prolonged baseline AV, the incidence of the primary outcome was 12.8% in patients randomized to aCRT compared with 27.4% in convCRT patients (HR = 0.45; 95% CI = 0.24-0.85; P=.01). Also, patients with AF episodes adjudicated as clinical adverse events were less common with aCRT (4.3%) than with convCRT (12.7%) (HR = 0.39; 95% CI = 0.19-0.79; P=.01).CONCLUSION Patients receiving aCRT had a reduced risk of AF compared with those receiving convCRT. Most of the reduction in AF occurred in subgroups with prolonged AV conduction at baseline and with significant left atrial reverse remodeling.