title: Device pacing diagnostics overestimate effective cardiac resynchronization therapy pacing results of the hOLter for Efficacy analysis of CRT (OLÉ CRT) study.
abstract: A high percentage of biventricular (BiV) or left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) devices has been associated with superior clinical outcomes. However, the percent ventricular (%V) pacing reported by CRT devices simply indicates the number of paces the device has delivered and not the proportion of pacing that has captured the LV effectively.
  
  
  
  The purpose of this study was to determine whether a beat-by-beat evaluation of effective pacing would provide a more accurate evaluation of CRT delivery.
  
  
  
  An automatic electrogram (EGM)-based algorithm that classifies each LV pace as effective or ineffective based on detection of QS/QS-r morphology on the unipolar LV EGM during pacing was developed and validated. LV EGMs that were recorded by 24-hour Holter from 57 CRT patients were postprocessed. The percent effective CRT (%e-CRT) pacing was calculated by dividing the time spent in e-CRT pacing by the total time of the recording.
  
  
  
  In this CRT cohort, the average %V pacing (94.8% ± 8%) significantly overestimated the %e-CRT pacing (87.5% ± 23%; P <.001). A significant minority of subjects (18%) had a discrepancy of at least 3 percentage points between %V pacing and %e-CRT pacing (mean 39% ± 41%).
  
  
  
  Current device pacing diagnostics overestimate the amount of CRT pacing actually delivered. The new algorithm quantifies ineffective CRT pacing, which enables clinicians to identify patients with this issue and to address the reasons behind suboptimal CRT delivery.
authors.affiliation: Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain. Electronic address: ahernandez.hrc@salud.madrid.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Madrid
authors.affiliation: Division of Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Facchin
authors.affiliation: Medtronic PLC, Cardiac Rhythm and Heart Failure Research, Minneapolis, Minnesota.
authors.forename: Ruth Nicholson
authors.initials: RN
authors.lastname: Klepfer
authors.affiliation: Medtronic PLC, Cardiac Rhythm and Heart Failure Research, Minneapolis, Minnesota.
authors.forename: Subham
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Matía
authors.affiliation: Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Moreno
authors.affiliation: Coronary Unit Department, Cardiology and Electrophysiology, ASST Bergamo Est, Ospedale Bolognini, Seriate, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Locatelli
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D015716:Electrocardiography, Ambulatory / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Biventricular pacing; Effective cardiac resynchronization therapy; Heart failure; Pacing; Resynchronization