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Survival After Rate-Responsive Programming in Patients With Cardiac Resynchronization Therapy-Defibrillator Implants

Brian Olshansky1, Mark Richards2, Arjun Sharma2

  • 1From the Mercy Hospital, Mason City, IA (B.O.); ProMedica Cardiology, Toledo, OH (M.R.); Boston Scientific, St Paul, MN (A.S., N.W., P.J., D.P.); and Cleveland Clinic, Cleveland, OH (B.L.W.). brian-olshansky@uiowa.edu.

Circulation. Arrhythmia and Electrophysiology
|August 13, 2016
PubMed

Insights

Rate-responsive pacing (DDDR) improved survival in cardiac resynchronization therapy defibrillator (CRT-D) patients with a high heart rate score (HRSc) of 70% or more. Lower HRSc patients did not benefit from DDDR pacing.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Rate-responsive pacing (DDDR) versus nonrate-responsive pacing (DDD) has shown no survival benefit for patients undergoing cardiac resynchronization therapy defibrillator (CRT-D) implants.
  • The heart rate score (HRSc), an indicator of heart rate variation, may predict survival.
  • Hypothesized that high-risk HRSc CRT-D patients will have improved survival with DDDR versus DDD alone.

Purpose of the Study:

  • To investigate the survival benefit of DDDR pacing in CRT-D patients with a high heart rate score (HRSc).
  • To determine if DDDR pacing improves survival in CRT-D patients with a baseline HRSc of 70% or higher.

Main Methods:

  • Utilized LATITUDE remote monitoring data from CRT-D patients (2006-2011) programmed initially to DDD.
  • Compared patients reprogrammed to DDDR with propensity-matched DDD controls, adjusting for key clinical variables.
  • Assessed survival using the Social Security Death Index and analyzed HRSc changes with DDDR reprogramming.

Main Results:

  • DDDR programming in CRT-D patients was associated with improved survival (adjusted hazard ratio = 0.77; P<0.001).
  • Patients with baseline HRSc ≥70% showed improved HRSc with DDDR and significantly better survival (hazard ratio = 0.74; P<0.001).
  • Patients with HRSc <70% experienced no survival benefit from DDDR reprogramming, despite HRSc improvement.

Conclusions:

  • In CRT-D patients with HRSc ≥70%, DDDR reprogramming improved HRSc and was associated with survival.
  • Patients with lower HRSc (<70%) did not experience a change in survival with DDDR programming.
  • Baseline HRSc is a critical factor in determining the survival benefit of DDDR pacing in CRT-D patients.
Abstract

Keywords:
cardiac resynchronization therapyheart rate scoremortalitypacemaker optimizationpacingrate-responsive pacing

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