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Adaptive CRT Algorithm—Reducing the Non-Responder in CRT Recipients With Left Bundle Branch Block and QRS 120–150 ms

      Background: Efficacy of the cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB), but QRS duration of 120–150 ms is still limited. Adaptive CRT algorithm had shown to be more effective in patients with preserved AV conduction but the impact of the Adaptive CRT algorithm in patients with different QRS duration remains uncertain. Methods: Patients with LBBB and preserved AV conduction enrolled in the Adaptive CRT trial, randomized study comparing the aCRT or echo-optimized CRT (control group), were used in this analysis. Endpoints for this analysis were clinical composite score (CCS) at 6 months post-implant and time to first heart failure (HF) hospitalization or death. Results: Among the 199 patients, 80 patients (40%) had a baseline QRS of 120–150 ms. In this subgroup, a greater proportion of aCRT patients had an improved CCS (79% vs 50%) at 6 months compared to the control group (P = .03). There was also a trend toward a lower risk of death or HF hospitalization (hazard ratio: 0.53; 95% CI: 0.24–1.15; P = .10) in aCRT group compared to the control arm. In the wide QRS subgroup, the efficacy was comparable in both treatment arms. Conclusion: Adaptive CRT was associated with improved patient outcomes over echo-optimized bi-ventricular CRT in patients with preserved AV conduction, LBBB, and QRS of 120–150 ms.
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