AdaptivCRT Education and Clinical Evidence

Clinical evidence shows that AdaptivCRT™ has helped to increase CRT response rate, reduce unnecessary right ventricular pacing, and improve clinical outcomes for patients with normal AV conduction.3-6 In addition, by promoting intrinsic RV conduction, AdaptivCRT reduces RV pacing and increases device longevity for patients with normal conduction.3-6

12% improvement in CRT response at 6 months*4

  • 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.4

46% reduction in AF risk comparing AdaptivCRT vs. Conventional CRT8

  • Patients with AdaptivCRT had a reduced risk of AF compared with those receiving conventional CRT.**8

48% lower risk of death or heart failure hospitalization4

  • 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.4

​59% reduction in patient's odds of a 30-day HF readmission compared to echo-optimized Biventricular pacing7

  • Use of AdaptivCRT is associated with a significant reduction in the probability of HF readmissions after both HF and all-cause hospitalizations.7

* Percentage of patients improved in Packer Clinical Composite Score (CCS) at 6-month follow-up. CCS is a composite measure of mortality, HF hospitalizations, and symptomatic changes.
** Most of the reduction in AF occurred in subgroups with prolonged AV conduction at baseline and with significant left atrial reverse remodeling.

Dynamic, Physiologic CRT

AdaptivCRT™ continuously and dynamically optimizes the cardiac resynchronization therapy (CRT) pacing method and AV/VV delays according to their conduction status and level of activity every minute.It leverages a patient’s intrinsic RV conduction when possible while still maintaining CRT. AdaptivCRT comprises two pacing operations: Adaptive LV and Adaptive BiV. 

The following three steps describe the general operation of the AdaptivCRT algorithm1-2 

  1. Assess intrinsic conduction every minute and determine if a patient’s AV interval is normal or prolonged.
  2. Based on that assessment, determine the pacing method to be either Adaptive LV, for normal AV intervals and heart rates < 100 bpm, or Adaptive BiV, for prolonged AV intervals and elevated heart rates.
  3. Optimize timing - For Adaptive LV pacing, the algorithm will determine when to pre-pace the LV to synchronize with the intrinsic RV activation. For Adaptive BiV pacing, the AV/VV delays will be optimized based on AV interval, P wave and QRS waveform width measurements.

This webpage is intended only for users in markets where Medtronic products and therapies are approved or available for use as indicated within the respective product manuals. Content on specific Medtronic products and therapies is not intended for users in markets that do not have authorization for use.

References

Medtronic VivaTM Quad XT CRT-D Clinician Manual, Medtronic, Inc., Minneapolis, MN, USA
Krum, et al. A novel algorithm for individualized cardiac resynchronization therapy: rationale and design of the adaptive cardiac resynchronization therapy trial. American Heart Journal 2012; 163: 747-752.
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: results of the adaptive CRT trial. Heart Rhythm. 2012; 9(11): 1807-1814.
Birnie D. et al., Clinical outcomes with synchronized left-ventricular pacing: analysis of the adaptive CRT trial. Heart Rhythm 2013; 10(9): 1368-1374.
5  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.
6 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. 
7 Starling RC, Krum H, Bril S, et al. Impact of a novel adaptive optimization algorithm on 30-day readmisions: evidence from the Adaptive CRT trial. JACC: Heart Failure 2015; doi:10.1016/j.jchf.2015.03.001
8 
Birnie D, Hudnall H, Lemke N et al. Continuous optimization of cardiac resynchronization therapy reduces atrial fibrillation in heart failure patients: Results of the Adaptive Cardiac Resynchronization Therapy Trial. Heart Rhythm. 2017;14:1820-1825
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. November 2012;15(7):A349.

Last updated: 
07 May 2018