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Purpose: The benefit of CRT can be improved through optimization of its pacing parameters. Adaptive CRT algorithm (aCRT) evaluates intrinsic electrical conduction once every minute and provides either LV or BIV pacing with dynamically optimized AV and VV delays. Safety and clinical efficacy of the aCRT has been demonstrated in theAdaptive CRT trial. We investigated whether the frequency of the AV delay adjustments by the algorithm was related to patients daily activity.Methods: Daily activity is measured by a sensor as a percentage of the day when the activity exceeds a certain threshold. For each patient an average daily activity over the FU (20.4±5.7 months) was calculated. Patients (n=314) were stratified into 4 quartiles according to their average daily activity. We calculated: a) the percent of the once-a-minute algorithm conduction measurements which led to a subsequent adjustment in the device AV delay and b) the percent of patients who improved in Packer's Clinical Composite Score (CCS) and worsened from pre-implant to FU; c) changes in the LV EF and left-ventricular end-systolic index (LV ESVi) over the 12-month FU. The F-test was used to compare the means across the quartiles.Results: Patients in higher quartiles of the daily activity levels had greater frequency of AV delay adjustments by the aCRT algorithm and were characterized by a greater proportion of responders to CRT as defined by the improvement in CCS. There were no significant differences in LV EF and LV ESVi changes across patient activity quartiles.View this table:Table 1. Frequency of AV delay adjustments by the aCRT algorithm and changes in clinical end-points from pre-implant to 12-month FU stratified by activity levelsConclusions: Patients with higher activity experience more frequent adjustments of AV delays by the Adaptive CRT algorithm and are characterized by a greater improvement in clinical condition.

More frequent optimization by the adaptive crt algorithm in patients with higher daily activity: analysis of the adaptive crt trial