Progressive Worsening in Device-Based Heart Failure Sensor Measurements are Associated with Sub-Optimal LV Pacing Percentages in CRT-D Patients

Abstract

Background Lower %LV pacing ( 35000 remotely monitored CRT patients. HeartLogic (HL), a heart failure (HF) composite index and alert algorithm available in both CRT-D and ICD devices, aggregates physiologic trends associated with multiple aspects of HF status (e.g. heart sounds, heart rate, thoracic impedance, respiration rate, tidal volume, and activity). HL alerts were recently shown to detect HF events with 70% sensitivity, and identify patients with 10-fold increased risk of worsening HF. Objective We plan to investigate association between daily % LV pacing and device measured individual heart failure sensors and HeartLogic. Methods The ALTITUDE database collects de-identified data recorded by the implanted devices from the LATITUDE remote monitoring system. Patients with HeartLogic enabled CRT-D devices and a minimum of 30 days of daily sensor data were included. All days with AF burden were excluded. Each patient day was grouped into 6 groups based on the daily % LV pacing values ( Results Out of 2736 CRT-D patients, 594 met the selection criteria had 248 alerts over 155.13 years. Sub-optimal LV pacing percentages were associated with progressively worse device sensor values (see figure). HeartLogic index reflected significant worsening even for a small reduction in % LV pacing. The proportion of days in HeartLogic alert was about 2x higher with Conclusion Lower %LV pacing is associated with multiple worsening heart failure sensors. This analysis provides strong evidence that the poor survival associated lower %LV pacing is likely caused by worsening heart failure.