Atrioventricular Optimization Improves Cardiac Resynchronization Response in Patients with Long Interventricular Electrical Delays: A Pooled Analysis of the SMART-AV and SMART-CRT Trials.
Cardiac resynchronization therapy
atrioventricular optimization
electrical delay
heart failure
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
27 Mar 2024
27 Mar 2024
Historique:
received:
07
03
2024
revised:
21
03
2024
accepted:
24
03
2024
medline:
12
4
2024
pubmed:
12
4
2024
entrez:
11
4
2024
Statut:
aheadofprint
Résumé
The utility of atrioventricular (AV) optimization (AVO) algorithms remains in question. A substudy of the SMART-AV trial found patients with prolonged interventricular (RV-LV) delays ≥70 ms were more likely to benefit from CRT with AVO. The SMART-CRT trial evaluated AVO based on these results, but the study was underpowered. To increase statistical power, data from SMART-AV patients meeting the inclusion criteria of RV-LV ≥70 ms were pooled with data from SMART-CRT to reassess AVO. SMART-CRT and SMART-AV were prospective, randomized, multicenter clinical trials. Patients in both studies were randomized to be programmed with an AVO algorithm (SmartDelay) or fixed AV delay (120 ms). Paired echocardiograms obtained at baseline and six months were compared, with CRT response defined as ≥15% reduction in left ventricle end systolic volume (LVESV). A total of 451 complete patient datasets were pooled and analyzed. The baseline demographics between studies did not differ statistically in terms of age, sex, LV ejection fraction, or LVESV. The AVO group had a greater proportion of CRT responders (SmartDelay: 73.9%, Fixed: 63.1%, p=0.014) and greater changes in measures of reverse remodeling. SmartDelay patients with a recommended sensed AV delay outside the nominal range (100-120 ms) had 2.3 greater odds of CRT response than fixed AV delay patients. Greater CRT response and measures of reverse remodeling were observed in patients with SmartDelay enabled versus a fixed AV delay. The present study supports the use of SmartDelay in patients with a CRT indication and interventricular delay ≥70 ms. ClinicalTrials.gov, NCT00677014 and NCT03089281.
Sections du résumé
BACKGROUND
BACKGROUND
The utility of atrioventricular (AV) optimization (AVO) algorithms remains in question. A substudy of the SMART-AV trial found patients with prolonged interventricular (RV-LV) delays ≥70 ms were more likely to benefit from CRT with AVO. The SMART-CRT trial evaluated AVO based on these results, but the study was underpowered.
OBJECTIVE
OBJECTIVE
To increase statistical power, data from SMART-AV patients meeting the inclusion criteria of RV-LV ≥70 ms were pooled with data from SMART-CRT to reassess AVO.
METHODS
METHODS
SMART-CRT and SMART-AV were prospective, randomized, multicenter clinical trials. Patients in both studies were randomized to be programmed with an AVO algorithm (SmartDelay) or fixed AV delay (120 ms). Paired echocardiograms obtained at baseline and six months were compared, with CRT response defined as ≥15% reduction in left ventricle end systolic volume (LVESV).
RESULTS
RESULTS
A total of 451 complete patient datasets were pooled and analyzed. The baseline demographics between studies did not differ statistically in terms of age, sex, LV ejection fraction, or LVESV. The AVO group had a greater proportion of CRT responders (SmartDelay: 73.9%, Fixed: 63.1%, p=0.014) and greater changes in measures of reverse remodeling. SmartDelay patients with a recommended sensed AV delay outside the nominal range (100-120 ms) had 2.3 greater odds of CRT response than fixed AV delay patients.
CONCLUSION
CONCLUSIONS
Greater CRT response and measures of reverse remodeling were observed in patients with SmartDelay enabled versus a fixed AV delay. The present study supports the use of SmartDelay in patients with a CRT indication and interventricular delay ≥70 ms.
CLINICAL TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov, NCT00677014 and NCT03089281.
Identifiants
pubmed: 38604592
pii: S1547-5271(24)02277-X
doi: 10.1016/j.hrthm.2024.03.1783
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03089281', 'NCT00677014']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.