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• W4377012375 abstract "Algorithms to automatically adjust atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) devices are common, but their clinical efficacy is unknown. We aimed to evaluate automatic CRT algorithms in patients with heart failure for the reduction of mortality, heart failure hospitalizations, and clinical improvement. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) in patients with CRT using automatic algorithms that change AV and VV intervals dynamically without manual input, on a beat-to-beat basis. We performed a subgroup analysis including intracardiac electrogram-based (EGM) algorithms and contractility-based algorithms. Eight RCTs with 4,913 participants were included, of whom 2,465 (50.1%) were randomized to automatic algorithm. Six of the eight trials used EGM-based algorithms, and two used contractility sensors. There was no difference in all-cause mortality (6.0% vs 6.3%; OR 0.92%; 95% CI 0.71-1.19; p=0.93; I2=0%) or heart failure hospitalizations (16.4% vs 17.5%; OR 0.98; 95% CI 0.77-1.24; p=0.45; I2=0%) between the automatic algorithm group and the control group. Study-defined clinical improvement was also not significantly different between groups (64.0% vs 56.8%; OR 1.05; 95% CI 0.85-1.25; p=0.63; I2=50%). In the contractility-based subgroup there was a trend towards greater clinical improvement with the use of the automatic algorithm (75% vs 68.3%; OR 1.45; 95% CI 0.97-2.18; p=0.07; I2=40%), which did not reach statistical significance. The overall risk of bias was low. Automatic algorithms that change AV or VV intervals did not improve mortality, heart failure hospitalizations, or cardiovascular symptoms in patients with heart failure and CRT.Tabled 1Table 1. Included studies. (MP-453089-3)Study NameInterventionsYearNAge (yrs)Male (%)NYHA 3 (%)LVEF, mean (%)QRS duration (mean)LBBB (%)AF (%)Definition of clinical improvementFollow-up (months)FREEDOM QUICKQuickOpt vs echo201616476673NANANANA0NYHA w/o hospitalization12ADAPTIV CRTAdaptivCRT vs echo2012522656995241557718Clinical composite score6SMART-AVSmartDelay vs Fixed 120 ms AV delay + echo20101014666895241537913NYHA6ZhangQuickOpt vs echo + ECG20191245960NA311431000NYHA48JensenQuickOpt vs echo2011486581392014610014NYHA12RESPOND CRTSonR contractility sensor vs. echo2017967676896NA. 32% of patients had LVEF < 25%1608616Alive, without HF events, with improvement in NYHA class24CLEARSonR contractility sensor vs. echo20121997363NA, mean NYHA was 326160NA0Death, HF hospitalization, NYHA, and quality of life12QUICK OPT CHRONICQuickOpt vs echo20183926073030153622NYHA12AF: atrial fibrillation. LBBB: left bundle branch block. LVEF: left ventricle ejection fraction. NA: not available. NYHA: New York Heart Association functional class. Open table in a new tab" @default.
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• W4377012375 date "2023-05-01" @default.
• W4377012375 modified "2023-10-18" @default.
• W4377012375 title "MP-453089-3 CLINICAL OUTCOMES OF AUTOMATIC AV AND VV INTERVAL ALGORITHMS IN CRT: SYSTEMATIC REVIEW AND META-ANALYSIS." @default.
• W4377012375 doi "https://doi.org/10.1016/j.hrthm.2023.03.481" @default.
• W4377012375 hasPublicationYear "2023" @default.
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