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Implantable Cardiac Devices
While CRT is a highly effective therapy, there remains a need to improve the percentage of patients who receive full benefits. Studies have shown that up to one-third of patients do not experience all of the benefits of CRT.1-6
Due to the complexity of heart failure disease, many factors contribute to CRT non-response, including suboptimal AV timing, suboptimal LV lead placement, presence of arrhythmias, and reduced BiV pacing.7
As part of its comprehensive approach to treating heart failure patients with CRT, Medtronic offers a variety of solutions across every stage of care, including ways to optimize CRT response.
Detail - Adequate CRT Response
Detail - Suboptimal CRT Response
For CRT-D devices, certain programming and device operations may not provide cardiac resynchronization therapy. Changes in a patient's disease and/or medications may alter the efficacy of a device's programmed parameters or related features and may impact longevity.
Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. NEJM. 2002;346(24):1845-1853.
Young JB, Abraham WT, Smith AL, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure; the MIRACLE ICD Trial. JAMA. 2003;289(20):2685-2694.
Abraham WT, Young JB, León AR, et al. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation. 2004;110(18):2864-2868.
Abraham WT, Leon AR, Hannon C, et al. Results of the InSync III Marquis clinical trial. Heart Rhythm. 2005;2(5): S65.
Chung ES, Leon AR, Tavazzi L, et al. Results of the Predictors of Response to CRT (PROSPECT) Trial. Circulation. 2008;117(20):2608-2616.
Abraham WT, Gras D, Yu CM, et al. Results from the FREEDOM Trial - assess the safety and efficacy of frequent optimization of cardiac resynchronization therapy. Presented at the Heart Rhythm Society annual scientific session, Denver, CO, May 2010.
Mullens W, Grimm RA, Verga T, et al. Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. JACC. 2009; 53(9):765-773.
Available in select Medtronic CRT devices, the AdaptivCRT algorithm is part of Medtronic's long tradition of innovative technologies that deliver physiologic pacing. These include dual chamber pacing, rate response, CRT, and MVP® mode.
The AdaptivCRT algorithm continuously and dynamically adapts CRT pacing method and AV/VV delays.1 By promoting intrinsic RV conduction, AdaptivCRT reduces RV pacing and increases device longevity for patients with normal AV conduction.1
Detail - AdaptivCRT Algorithm
For CRT-D devices, certain programming and device operations may not provide cardiac resynchronization therapy. Changes in a patient's disease and/or medications may alter the efficacy of a device's programmed parameters or related features and may impact longevity.
Watch these videos to learn more about the AdaptivCRT algorithm.
Medtronic Viva XT CRT-D Clinician Manual, Medtronic, Inc., Minneapolis, MN, USA.
Clinical Evidence
AdaptivCRT improved patient outcomes compared to echo-optimized CRT.1-5
Detail - 12% Improvement in Clinical Outcomes
Detail - Reduced Risk of HF Hospitalization
Detail - Reduced Hospital Readmissions
For CRT-D devices, certain programming and device operations may not provide cardiac resynchronization therapy. Changes in a patient's disease and/or medications may alter the efficacy of a device's programmed parameters or related features and may impact longevity.
Singh JP, Abraham WT, Chung ES, et al. Clinical response with adaptive CRT algorithm compared with CRT with echocardiography-optimized atrioventricular delay: a retrospective analysis of multicentre trials. Europace. 2013;15(11):1622-1628.
Martin DO, Lemke B, Birnie D, et al. Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy. Heart Rhythm. 2012;9(11):1807-1814.
Birnie D, Lemke B, Aonuma K, et al. Clinical outcomes with synchronized left ventricular pacing: analysis of the adaptive CRT trial. Heart Rhythm. 2013;10(9):1368-1374.
Martin D, Lemke B, Aonuma K, et al. Clinical outcomes with adaptive cardiac resynchronization therapy: long-term outcomes of the adaptive CRT trial. HFSA Late Breakers. September 23, 2013.
Tarab AD, Dougher CE, Rogers TB, et al. Budget impact of selecting cardiac resynchronization therapy (CRT) devices with adaptive (aCRT) programming algorithms under the United States Medicare Payment Setting. Value Health. 2012;15(7):A349.
Starling RC, Krum H, Bril S, et al. Impact of novel adaptive optimization algorithms on 30-day readmissions: evidence from the Adaptive CRT Trial. HRS 2014 Poster Session.
Armed with Bigger Fines, Medicare to Punish 2,225 Hospitals for Excess Readmissions. Kaiser Health News. August 2, 2013.