PO-686-01 ASSOCIATION OF CLOSED-LOOP STIMULATION VERSUS ACCELEROMETER-BASED RATE ADAPTIVE PACING ON PHYSICAL ACTIVITY AND OUTCOMES IN PATIENTS WITH CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES

Abstract

Patients with sinus node dysfunction benefit from atrial pacing with rate-adaptive pacing. An alternative to the standard accelerometer (XL), closed-loop stimulation (CLS) relies on intracardiac impedance measurements to allow for a more physiological response to all forms of stimulation. We aimed to evaluate and compare the baseline characteristics, remote monitoring serial data, and long-term outcomes between CLS and XL among three cohorts: 1) dual-chamber pacemaker (DC-PM); 2) dual-chamber implantable cardiac defibrillator (DC-ICD); and 3) cardiac resynchronization therapy (CRT). We used the Biotronik CERTITUDE remote monitoring database, including all Medicare insured patients aged ≥ 65 years with a device programmed to XL or CLS. Remote monitoring data was collected and compared across the cohorts with high arrhythmia burden defined as greater than the median, while chronic conditions and long-term outcomes were obtained via linkage to Medicare claims data. A total of 6,085 patients (mean baseline atrial pacing percentage 63.7%, SD ± 28.8) were included and stratified into respective three respective cohorts: DC-PM (4,346 CLS and 524 XL), DC-ICD (CLS 290 and XL 168), and CRT (CLS 383 and XL 374). Prior stroke and no obesity were predictors of CLS in the DC-PM cohort, while atrial fibrillation was a predictor for XL in the DC-ICD cohort. After multivariable adjustment using a backward selection model, as compared to XL, those with CLS were observed to have 0.5% greater levels of physical activity in the DC-PM cohort (mean 9.3% vs. mean 8.7%, p=0.01), 2.2% lower in the DC-ICD cohort (p<0.001), 1.1% lower in the CRT cohort (p<0.001). There was a significantly lower risk of atrial arrhythmias (OR 0.56, 95% CI 0.39 - 0.81, p = 0.002) and lower PVC burden (OR 0.66, 95% CI 0.47 - 0.93, p=0.02) with CLS as compared to XL in the DC-PM, while no differences were observed in the other cohorts. There were no significant differences between CLS and XL in any cohort with respect to 1-year outcomes linked to Medicare including all-cause hospitalization, cardiac hospitalization, and stroke. As compared to XL, those programmed to CLS had modestly higher physical activity levels and lower risk of high atrial arrhythmias and PVC burden in those with a DC-PM as compared to XL.