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AdaptivCRT Algorithm Cardiac Device Features

Overview

The AdaptivCRT™ Algorithm Optimizes CRT Pacing Every Minute Whether AV Conduction Is Normal, Prolonged, or Blocked

It adapts to meet the constantly changing needs of CRT patients because it responds to what he or she is doing and automatically decides when and how to pace the heart. 

The AdaptivCRT Algorithm has two different modes:

  • AdaptivCRT LV Only Pacing occurs during normal AV conduction when the heart rate is less than or equal to 100 beats per minute. It also optimizes A-V timing and minimizes right ventricular (RV) pacing.
  • AdaptivCRT BiV Pacing occurs during prolonged/blocked AV conduction or when the heart rate is greater than 100 beats per minute. It also optimizes A-V and V-V timing. 

For more information on the AdaptivCRT Algorithm feature go to: https://www.medtronicacademy.com/features/adaptivcrt-feature

Image of AdaptivCRT LV Only pacing and AdaptivCRT BiV pacing.

AdaptivCRT Algorithm Clinical Evidence

The AdaptivCRT Algorithm is associated with a 31% relative reduction in mortality1 (after adjusting for other potential risk factors*)

Analysis Design

1,835 patients with a CRT system were enrolled in the Medtronic Product Surveillance Registry. We compared patients with AdaptivCRT on versus off to evaluate mortality status between the two groups. Frailty survival models were used to evaluate the potential survival benefit of the algorithm, adjusting for patient heterogeneity and center variability.

Results

Patients who received AdaptivCRT were associated with a 31% relative reduction in all-cause mortality versus conventional CRT (after adjusting for other potential risk factors*).

 

Total Survival AdaptivCRT vs. Standard CRT

Chart showing that AdpativCRT Is associated with a 31% relative reduction in mortality
*

Age, gender, LVEF, NYHA Class, QRS duration, AF, CAD, Hypertension, AV Block, and LBBB.

The AdaptivCRT Algorithm showed a 12% improvement in CRT response at 6 months*2

Objective

To examine whether synchronized left ventricular pacing resulted in better outcomes

Study Design

  • Control n = 91
  • AdaptivCRT arm n = 150
  • Retrospective sub-analysis

Results

In patients with normal AV conduction, the AdaptivCRT Algorithm provided mostly Synchronized LV Pacing and demonstrated better clinical outcomes compared to echocardiography-optimized Biventricular pacing

Chart showing that AdpativCRT Showed a 12% improvement in CRT response at 6 months
*

Clinical Composite Score is a composite measure of mortality, HF hospitalizations, and symptomatic changes.

The AdaptivCRT Algorithm showed a 46% reduction in AF risk*3

Objective

To compare the long-term effects of AdaptivCRT with conventional cardiac resynchronization (convCRT) therapy pacing on the incidence of AF

Analysis Design

  • N = 472
  • Post-hoc sub-analysis

Results

Patients with AdaptivCRT had a reduced risk of AF compared with those receiving conventional CRT*

Incidence of Primary End Point
(≥48 consecutive hours of atrial tachycardia/atrial fibrillation)

Chart showing that AdpativCRT showed a 46% reduction in AF risk
*

Most of the reduction in AF occurred in subgroups with prolonged AV conduction at baseline and with significant left atrial reverse remodeling.

The AdaptivCRT Algorithm showed  a 35% reduction in AF risk4

Analysis Design

44,838 patients in the Medtronic CareLink™ database were compared for the risk of incident continuous AF > 48 hours based on the programmed use of AdaptivCRT versus standard BiV pacing.

Results

  • In a large cohort of patients implanted with CRT-D, AdaptivCRT was associated with a reduced risk of developing AF by 35% (p < 0.0001).*
  • Patients with shorter and longer PR intervals both had lower incidence of AF with AdaptivCRT.
  • A higher percentage of LV-only pacing during AdaptivCRT was also associated with lower incidence of AF.

Incidence of Atrial Fibrillation

Chart showing that AdpativCRT showed a 35% reduction in AF risk
*

Kaplan-Meier methods and the log-rank test were used to compare groups’ time to first occurrence of 48 hours of AF. 48 hours of AF was defined to be 2 consecutive days of > 23 hours of AF as measured by the device.

The AdaptivCRT Algorithm showed a 59% reduction in a patient’s odds of a 30-day HF readmission5

Objective

To investigate the impact of the Medtronic AdaptivCRT algorithm on 30-day readmissions after heart failure and all-cause index hospitalizations

Analysis Design

  • N = 478
  • Retrospective analysis

Results

Use of AdaptivCRT is associated with a significant reduction in the probability of HF readmissions after both HF and all-cause hospitalizations

Kaplan-Meier Curves of Hospital Readmissions 

Chart showing AdaptivCRT showed a 59% reduction in a patient’s odds of a 30-day HF readmission
1

Singh JP, et al. Improved Survival With Dynamic Optimization Of CRT Pacing Using AdaptivCRT Algorithm: Analysis Of Real-world Patient Data. Presented at HRS 2018 (Abstract B-AB37 -06).

2

Birnie D, et al. Heart Rhythm. 2013;10:1368-1374.

3

Birnie D, et al. Heart Rhythm. 2017;14:1820-1825.

4

Hsu J, et al. Heart Rhythm. 2017;14:S86

5

Starling RC, et al. JACC Heart Fail. 2015;3:565-572.