AI Article Synopsis
- The study investigates the effectiveness of atrioventricular optimization (AVO) algorithms in cardiac resynchronization therapy (CRT), particularly for patients with interventricular delays of 70 ms or more, combining data from the SMART-AV and SMART-CRT trials for increased statistical power.
- Results show that patients using the SmartDelay AVO algorithm had a higher CRT response rate (73.9%) compared to those with a fixed AV delay (63.1%), indicating better heart function improvement.
- The findings suggest that SmartDelay is beneficial for CRT patients with significant interventricular delays, advocating for its use in clinical practice.
Article Abstract
Background: The utility of atrioventricular (AV) optimization (AVO) algorithms remains in question. A substudy of the SMART-AV trial found that patients with prolonged interventricular delays ≥70 ms were more likely to benefit from cardiac resynchronization therapy (CRT) with AVO. The SMART-CRT trial evaluated AVO on the basis of these results, but the study was underpowered.
Objective: To increase statistical power, data from SMART-AV patients meeting the inclusion criterion of interventricular delay ≥70 ms were pooled with data from SMART-CRT to reassess AVO.
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 6 months were compared, with CRT response defined as ≥15% reduction in left ventricular end-systolic volume.
Results: A total of 451 complete patient data sets were pooled and analyzed. The baseline demographics between studies did not differ statistically in terms of age, sex, left ventricular ejection fraction, or left ventricular end-systolic volume. The AVO group had a greater proportion of CRT responders (SmartDelay, 73.9%; fixed, 63.1%; P = .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: Greater CRT response and measures of reverse remodeling were observed in patients with SmartDelay enabled vs a fixed AV delay. This study supports the use of SmartDelay in patients with a CRT indication and interventricular delay ≥70 ms.
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| http://dx.doi.org/10.1016/j.hrthm.2024.03.1783 | DOI Listing |
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