Abstract 13413: Atrial Fibrillation Impacts Adherence to Heart Rhythm Society Recommendations for Achieving High Bi-Ventricular Pacing Percentage in US Clinics
Background: Achieving a high biventricular pacing percentage (BIVP%) in patients (pts) with atrial fibrillation (AF) and a cardiac resynchronization (CRT) device is recommended by the Heart Rhythm Society Expert Consensus statement to obtain maximal benefit from CRT and is often dependent on aggressive atrioventricular nodal (AVN) blockade. The rates of achieving effective AVN blockade may vary among institutional clinics. This study was performed to compare the BIVP% achieved across US clinics among CRT pts.
Methods: Pts enrolled in Medtronic Carelink remote monitoring were included if they had: a CRT-defibrillator (CRT-D) programmed to BIVP, an atrial lead, and > 30 days of diagnostic data. We used continuous device diagnostics to classify AF as persistent or permanent (PERS/PERM) if lasting ≥ 23 hours for ≥ 7 consecutive days. Others were classified as no/Paroxysmal AF. Clinics were included if they had ≥ 10 pts with PERS/PERM AF. We totaled the BIVP% for each pt at the remote transmission 6 months post-CRT implant, determined the % of pts with high BIVP%; (> 95% BIVP) in each clinic, and compared the percentage of patients with high BIVP% across clinics.
Results: The 303 clinics that met inclusion criteria managed 39,146 pts (mean 129 ± 95 pts/clinic, mean age 70, 73% male) and of these 6,700 (17%) had PERS/PERM AF (mean 22 ± 15 PERS/PERM pts/clinic). Clinics were significantly less likely to obtain high BIVP% in PERS/PERM AF pts than in no/ Paroxysmal AF pts (p<0.001) and there was over 3x as much clinic variation in PERS/PERM AF pts.
Conclusion: There is profound variation in the % of pts with high BIVP% across US clinics; this variation is greater in pts with PERS/PERM AF than in pts with no/Paroxysmal AF. In PERS/PERM AF pts, the highest performing US clinics are able to achieve high BIVP% in 71% pts while many clinics obtain high BIVP% in fewer than half of pts. These data suggest that aggressive AVN blockade and AVN ablation are underused in pts with PERS/PERM AF and CRT devices.
- © 2013 by American Heart Association, Inc.