Abstract 11446: Impact of Higher Synchronized Left Ventricular Pacing Rate for Prognosis on Cardiac Resynchronization Therapy

Abstract

Background: The adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular pacing (sLVP) to produce fusion with the intrinsic right ventricular activation in normal atrioventricular (AV) conduction. Although sLVP has benefits over biventricular pacing (BiV), the adequate sLVP rate for better clinical outcome is still unclear. Purpose: The aim of this study was to assess the association between sLVP rate and clinical outcome. Methods: Among our cohort of 271 consecutive patients who had CRT implantation between April 2016 and August 2021, we evaluated 63 CRT patients without considerably prolonged AV conduction to whom we applied the aCRT algorithm (48 males, mean age: 64±14 years old, and the median follow up period: 316 days [interquartile range: 212-809days]). Results: At follow-up 6 months after CRT implantation, the frequency of CRT responder was 71% (n=45). The sLVP rate was significantly higher in responder compared to non-responder (75±30 vs 47±40 %, p=0.003). Receiving operating characteristics (ROC) curve analysis revealed that optimal cut-off value during sLVP rate was 59.4% for prediction of CRT responder (an area under the curve: 0.70, sensitivity: 80%, specificity: 61%, positive predictive value: 84%, and negative predictive value: 55%). Kaplan-Meier analysis demonstrated that higher sLVP group (sLVP≥59.4%, n=43) had better prognosis (cardiac death and heart failure hospitalization) compared to lower sLVP group (sLVP<59.4%, n=20) (log-rank p<0.001) (Figure) and multivariate Cox hazard analysis revealed that higher rate was associated with good prognosis (p<0.001). Conclusion: sLVP was associated with CRT response and higher sLVP rate (≥59.4%) may be important for good prognosis in patient with aCRT.